1912074303 NPI number — EAST SPRINGFIELD VOLUNTEER FIRE DEPARTMENT

Table of content: (NPI 1912074303)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912074303 NPI number — EAST SPRINGFIELD VOLUNTEER FIRE DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST SPRINGFIELD 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:
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:
1912074303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
836 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25701-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-521-1576
Provider Business Mailing Address Fax Number:
304-521-1576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9845 CR 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43910-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-543-3563
Provider Business Practice Location Address Fax Number:
304-521-1576
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YOHO
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
J
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
740-543-4047

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  020423250 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ========= . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 001705085 . This is a "MT STATE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0619629 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590004478 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000155352 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 590004478 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: ========= . This is a "MED MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 800231 . This is a "BLACK LUNG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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