Provider Demographics
NPI:1518079912
Name:CITY OF CANAL FULTON
Entity Type:Organization
Organization Name:CITY OF CANAL FULTON
Other - Org Name:CANAL FULTON FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-854-6761
Mailing Address - Street 1:155 E MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-1305
Mailing Address - Country:US
Mailing Address - Phone:330-854-2225
Mailing Address - Fax:330-854-6260
Practice Address - Street 1:1165 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-1075
Practice Address - Country:US
Practice Address - Phone:330-854-2456
Practice Address - Fax:330-854-0619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CANAL FULTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020326150341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000176075OtherBCBS
OH2209014Medicaid
OHP0042517OtherRR MEDICARE
OHP0042517OtherRR MEDICARE
OH000000176075OtherBCBS
OH=========001OtherMEDMUTUAL