Provider Demographics
NPI:1679659635
Name:BOLIVAR VOLUNTEER FIRE DEPARTMENT, INC.
Entity Type:Organization
Organization Name:BOLIVAR VOLUNTEER FIRE DEPARTMENT, INC.
Other - Org Name:BOLIVAR VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-874-3115
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-0136
Mailing Address - Country:US
Mailing Address - Phone:330-874-3115
Mailing Address - Fax:
Practice Address - Street 1:456 WATER STREET
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612
Practice Address - Country:US
Practice Address - Phone:330-874-3115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOLIVAR VOLUNTEER FIRE DEPARTMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-31
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020346250341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00118186OtherRRMEDICARE
OH000000215790OtherBCBS
OH2028102Medicaid
OH000000215790OtherBCBS
OH000000215790OtherBCBS