1245281427 NPI number — CUMBERLAND TRAIL FIRE DISTRICT NO 4

Table of content: (NPI 1245281427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245281427 NPI number — CUMBERLAND TRAIL FIRE DISTRICT NO 4

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMBERLAND TRAIL FIRE DISTRICT NO 4
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:
6
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:
1245281427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 505
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CLAIRSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43950-0505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-695-5147
Provider Business Mailing Address Fax Number:
740-695-6630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 S MARIETTA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST CLAIRSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43950-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-695-5147
Provider Business Practice Location Address Fax Number:
740-695-6630
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
740-695-5147

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020321551 , 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: 020321550 . This is a "BOARD OF PHARMACY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590005867 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000212164 . This is a "MT. STATE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 892909 . This is a "BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000155729 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0791933 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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