Provider Demographics
NPI:1285673160
Name:VILLAGE OF CLINTON
Entity Type:Organization
Organization Name:VILLAGE OF CLINTON
Other - Org Name:CLINTON FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-882-3752
Mailing Address - Street 1:7717 CLEVELAND MASSILLON RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-8912
Mailing Address - Country:US
Mailing Address - Phone:330-882-4828
Mailing Address - Fax:330-882-5220
Practice Address - Street 1:7717 CLEVELAND MASSILLON RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OH
Practice Address - Zip Code:44216-8912
Practice Address - Country:US
Practice Address - Phone:330-882-4828
Practice Address - Fax:330-882-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0914550341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2490791Medicaid
OH000000212831OtherBCBS
OH9301221Medicare PIN