Provider Demographics
NPI:1770507840
Name:NATIONAL TRAIL VOLUNTEER FIRE
Entity Type:Organization
Organization Name:NATIONAL TRAIL VOLUNTEER FIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-787-2466
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:GRATIOT
Mailing Address - State:OH
Mailing Address - Zip Code:43740-0165
Mailing Address - Country:US
Mailing Address - Phone:740-787-2466
Mailing Address - Fax:740-787-1026
Practice Address - Street 1:362 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:GRATIOT
Practice Address - State:OH
Practice Address - Zip Code:43740-0165
Practice Address - Country:US
Practice Address - Phone:740-787-2466
Practice Address - Fax:740-787-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHEMS.0203097003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2398534Medicaid
OH9326741Medicare PIN