Provider Demographics
NPI:1699829895
Name:ROBERTSVILLE VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:ROBERTSVILLE VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-862-2117
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:ROBERTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44670-0031
Mailing Address - Country:US
Mailing Address - Phone:330-862-2117
Mailing Address - Fax:330-862-2117
Practice Address - Street 1:11185 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:ROBERTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44670
Practice Address - Country:US
Practice Address - Phone:330-862-2117
Practice Address - Fax:330-862-2117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020487200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2892277Medicaid
OH9372721Medicare PIN