Provider Demographics
NPI:1568461127
Name:NORTHWEST FIRE AND AMBULANCE DISTRICT
Entity Type:Organization
Organization Name:NORTHWEST FIRE AND AMBULANCE DISTRICT
Other - Org Name:NORTHWEST EMERGENCY SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-437-7285
Mailing Address - Street 1:836 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1407
Mailing Address - Country:US
Mailing Address - Phone:800-676-4785
Mailing Address - Fax:304-522-4222
Practice Address - Street 1:135 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:OH
Practice Address - Zip Code:45347-1151
Practice Address - Country:US
Practice Address - Phone:937-437-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0206380003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200242230AMedicaid
OH590003853OtherRR MEDICARE
OH0230404Medicaid
000000038711OtherANTHEM
OH=========00OtherOH WORKERS COMP
OH0230404Medicaid