1750484689 NPI number — SPIRIT OF 76 VOLUNTEER FIRE DEPARTMENT

Table of content: (NPI 1750484689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750484689 NPI number — SPIRIT OF 76 VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPIRIT OF 76 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:
1750484689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53890 KEY BELLAIRE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLAIRE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43906-9479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-676-1551
Provider Business Mailing Address Fax Number:
740-676-1608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53890 KEY BELLAIRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLAIRE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43906-9479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-676-1551
Provider Business Practice Location Address Fax Number:
740-676-1608
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COFFIELD
Authorized Official First Name:
ZACHARY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
304-905-3545

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: 000000315291 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2249525 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810006875 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB570 . This is a "HEALTH PLAN/HOMETOWN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 001705095 . This is a "MOUNTAIN STATE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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