1629157888 NPI number — BURTON VOLUNTEER FIRE DEPARTMENT

Table of content: (NPI 1629157888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629157888 NPI number — BURTON VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURTON VOLUNTEER FIRE DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629157888
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13828 SPRING STREET
Provider Second Line Business Mailing Address:
P. O. BOX 243
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44021-0243
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-834-4416
Provider Business Mailing Address Fax Number:
440-834-0490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13828 SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-707-6753
Provider Business Practice Location Address Fax Number:
614-890-2947
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SESTAK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
14408344416

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2482068 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000187856 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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