Jefferson Township

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

JEFFERSON TOWNSHIP

Practice address

6767 Havens Corners Rd
Blacklick, OH 43004-8317

Phone

(614) 861-3757

NPI assigned

Aug 17, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bradford Lynn Shull

Title

Chief

Phone

(614) 861-3757

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1275525131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 392907",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152519900",
            "telephone_number": "800-962-1484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6767 HAVENS CORNERS RD",
            "city": "BLACKLICK",
            "state": "OH",
            "postal_code": "430048317",
            "telephone_number": "614-861-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON TOWNSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "SHULL",
        "authorized_official_first_name": "BRADFORD",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "614-861-3757"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000239608",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2363633",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590015315",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James N Jacobs
• Alpha O Jalloh, LPN
• Michael James
• Sanhita Jana, DDS
• Stefani Jo Jeffers, LPN
• Rylee Jefferson
• Brittany Johnson
• Itzia Y Johnson
• Latricia Johnson
• Melinda Johnson

• Land Ambulance in Blacklick, OH
• Providers in Blacklick, OH by specialty
• Land Ambulance in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.