Provider Demographics
NPI:1568444859
Name:BURGHILL-VERNON VOLUNTEER FIRE DEPARTMENT ASSOCIATION
Entity Type:Organization
Organization Name:BURGHILL-VERNON VOLUNTEER FIRE DEPARTMENT ASSOCIATION
Other - Org Name:BURGHILL VERNON FIRE DEPT
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-448-6220
Mailing Address - Street 1:6915 B STATE ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:KINSMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44428-9790
Mailing Address - Country:US
Mailing Address - Phone:330-448-6220
Mailing Address - Fax:330-448-6220
Practice Address - Street 1:6915 STATE ROUTE 88
Practice Address - Street 2:
Practice Address - City:KINSMAN
Practice Address - State:OH
Practice Address - Zip Code:44428-9790
Practice Address - Country:US
Practice Address - Phone:330-772-3013
Practice Address - Fax:330-772-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000222423OtherANTHEM
590006513OtherRAILROAD
OH0481170Medicaid
PA1013255690001Medicaid
OH=========00OtherWORK COMP
PA1013255690001Medicaid
OH=========00OtherWORK COMP