Provider Demographics
NPI:1497991293
Name:CITY OF ASHTABULA OHIO
Entity Type:Organization
Organization Name:CITY OF ASHTABULA OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-992-7190
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:4326 MAIN AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6853
Practice Address - Country:US
Practice Address - Phone:440-992-7190
Practice Address - Fax:440-992-2691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00775774OtherRAILROAD MEDICARE
OH3021965Medicaid
OH3021965Medicaid