Provider Demographics
NPI:1609274869
Name:EAST WAYNE FIRE DISTRICT
Entity Type:Organization
Organization Name:EAST WAYNE FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-828-8236
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-0134
Mailing Address - Country:US
Mailing Address - Phone:330-828-8236
Mailing Address - Fax:330-828-2998
Practice Address - Street 1:146 NORTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618-0134
Practice Address - Country:US
Practice Address - Phone:330-828-8236
Practice Address - Fax:330-828-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022452200341600000X
OH022452201341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152167Medicaid
OHP01739258OtherRAILROAD MEDICARE
OH0152167Medicaid
OHH375620Medicare PIN