Provider Demographics
NPI:1114926771
Name:NORTHERN PENDLETON FIRE DISTRICT
Entity Type:Organization
Organization Name:NORTHERN PENDLETON FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIT GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-472-5127
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:5900 KY HWY 154
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:KY
Practice Address - Zip Code:41006-9005
Practice Address - Country:US
Practice Address - Phone:859-472-5127
Practice Address - Fax:859-472-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15873416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY080049900OtherBLACK LUNG
KY590015144OtherRAILROAD MEDICARE
KY000000032237OtherANTHEM
KY55000590Medicaid
OH2398703Medicaid
KY55000590Medicaid
OH=========00OtherOH WORKERS COMP
OH2398703Medicaid
KY=========OtherTRICARE