Provider Demographics
NPI:1790739290
Name:DALTON VOLUNTEER FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:DALTON VOLUNTEER FIRE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSIT CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-828-8236
Mailing Address - Street 1:146 N CHURCH ST
Mailing Address - Street 2:P.O. BOX 134
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9422
Mailing Address - Country:US
Mailing Address - Phone:330-828-8236
Mailing Address - Fax:330-828-2998
Practice Address - Street 1:146 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618-9422
Practice Address - Country:US
Practice Address - Phone:330-828-8236
Practice Address - Fax:330-828-2998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DALTON VOLUNTEER FIRE DEPARTMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020760950341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0593951Medicaid
OH=========00OtherBWC
OHP00720014Medicare PIN
OH=========00OtherBWC