Provider Demographics
NPI:1538169750
Name:CITY OF OXFORD
Entity type:Organization
Organization Name:CITY OF OXFORD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DETHERAGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:513-523-6324
Mailing Address - Street 1:PO BOX 42426
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-0426
Mailing Address - Country:US
Mailing Address - Phone:855-626-9660
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:217 ELM STREET
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1120
Practice Address - Country:US
Practice Address - Phone:513-523-6324
Practice Address - Fax:513-524-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
OH02-1916500341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000357359OtherANTHEM
OH2555060Medicaid
OHP00209722OtherRAILROAD MEDICARE
OH9351931Medicare PIN