Provider Demographics
NPI:1265632640
Name:SMITHFIELD EMERGENCY SQUAD INC
Entity Type:Organization
Organization Name:SMITHFIELD EMERGENCY SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY -TREASURE
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:EAKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-733-8330
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43948-0549
Mailing Address - Country:US
Mailing Address - Phone:740-733-8126
Mailing Address - Fax:
Practice Address - Street 1:1028 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:OH
Practice Address - Zip Code:43948
Practice Address - Country:US
Practice Address - Phone:740-733-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000371048OtherBCBS
OH0326838Medicaid
OH000000371048OtherBCBS
OH9287641Medicare PIN