Provider Demographics
NPI:1306847017
Name:OR & W FIRE DISTRICT
Entity Type:Organization
Organization Name:OR & W FIRE DISTRICT
Other - Org Name:VILLAGE OF SHADYSIDE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-676-1910
Mailing Address - Street 1:PO BOX 6230
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:304-242-7106
Mailing Address - Fax:304-242-7108
Practice Address - Street 1:4210 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SHADYSIDE
Practice Address - State:OH
Practice Address - Zip Code:43947-1211
Practice Address - Country:US
Practice Address - Phone:740-676-1910
Practice Address - Fax:740-676-1084
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OR & W FIRE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-03
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0203137003416L0300X
OH02031370013343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH346002612OtherRAILROAD MEDICARE
OH346002612000OtherBWC STATE OF OHIO
OH2413605Medicaid
OH346002612000OtherBWC STATE OF OHIO