Provider Demographics
NPI:1710979570
Name:CITY OF WHITEHALL
Entity Type:Organization
Organization Name:CITY OF WHITEHALL
Other - Org Name:WHITEHALL DIVISION OF FIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-237-0831
Mailing Address - Street 1:PO BOX 713710
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-3710
Mailing Address - Country:US
Mailing Address - Phone:937-424-3701
Mailing Address - Fax:937-291-2971
Practice Address - Street 1:390 S YEARLING RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-1876
Practice Address - Country:US
Practice Address - Phone:614-237-0831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0298950341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00092972OtherRAILROAD MEDICARE
OH000000313178OtherANTHEM
OH2441236Medicaid
OH9338451Medicare PIN