Provider Demographics
NPI:1487683538
Name:CITY OF MARYSVILLE
Entity Type:Organization
Organization Name:CITY OF MARYSVILLE
Other - Org Name:MARYSVILLE FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-642-2065
Mailing Address - Street 1:PO BOX 77000 DEPT 771776
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2000
Mailing Address - Country:US
Mailing Address - Phone:855-626-9660
Mailing Address - Fax:833-953-0588
Practice Address - Street 1:16300 COUNTY HOME RD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8145
Practice Address - Country:US
Practice Address - Phone:937-642-2065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5575855Medicaid
OH590001451OtherRAILROAD MEDICARE
OH000000229549OtherANTHEM
OH590001451OtherRAILROAD MEDICARE
OH5575855Medicaid
OH=========002OtherMEDICAL MUTUAL OF OHIO
OH9179781Medicare PIN