Provider Demographics
NPI:1154482172
Name:FAIRFIELD TOWNSHIP
Entity Type:Organization
Organization Name:FAIRFIELD TOWNSHIP
Other - Org Name:FAIRFIELD TOWNSHIP VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-343-9711
Mailing Address - Street 1:5311 JOHNSTOWN RD NE
Mailing Address - Street 2:
Mailing Address - City:MINERAL CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44656-9046
Mailing Address - Country:US
Mailing Address - Phone:330-343-9711
Mailing Address - Fax:
Practice Address - Street 1:6288 FIREHOUSE STREET
Practice Address - Street 2:
Practice Address - City:SOMERDALE
Practice Address - State:OH
Practice Address - Zip Code:44678
Practice Address - Country:US
Practice Address - Phone:330-859-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRFIELD TOWNSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020893850341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000176079OtherANTHEM BCBS
OH0377542Medicaid
OH0377542Medicaid
OH=========004OtherMED MUTUAL
OH=========026OtherCARESOURCE
OH=========00OtherWORKERS COMP