Provider Demographics
NPI:1225335177
Name:ANTRIM COMMUNITY VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:ANTRIM COMMUNITY VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-510-0257
Mailing Address - Street 1:20217 CADIZ RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43973-9614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20217 CADIZ RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:OH
Practice Address - Zip Code:43973-9614
Practice Address - Country:US
Practice Address - Phone:740-510-0257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3154036Medicaid
OH9393361Medicare PIN