Organization
COUNTY OF TRUMBULL LIBERTY TOWNSHIP TRUSTEES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG THEOBALD (CHIEF)
(330) 759-0363
Entity
Organization
Contact information
Practice address
4001 LOGAN WAY, YOUNGSTOWN, OH 44505-1728
(800) 962-1484
(513) 772-4464
Mailing address
PO BOX 392907, PITTSBURGH, PA 15251-9907
(800) 962-1484
(513) 772-4464
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000155990
ANTHEM
OH
05
—
0266466
—
OH
01
—
441590280
RAILROAD MEDICARE
OH
Enumeration date
06/18/2006
Last updated
05/16/2024
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