Provider Demographics
NPI:1750484689
Name:SPIRIT OF 76 VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:SPIRIT OF 76 VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:COFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-905-3545
Mailing Address - Street 1:53890 KEY BELLAIRE RD
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-9479
Mailing Address - Country:US
Mailing Address - Phone:740-676-1551
Mailing Address - Fax:740-676-1608
Practice Address - Street 1:53890 KEY BELLAIRE RD
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-9479
Practice Address - Country:US
Practice Address - Phone:740-676-1551
Practice Address - Fax:740-676-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000315291OtherBLUE CROSS BLUE SHIELD
OH2249525Medicaid
WV3810006875Medicaid
OHAMB570OtherHEALTH PLAN/HOMETOWN
WV001705095OtherMOUNTAIN STATE
OH000000315291OtherBLUE CROSS BLUE SHIELD
OH9296401Medicare PIN
OH2249525Medicaid