Provider Demographics
NPI:1013946284
Name:VILLAGE OF BELOIT
Entity Type:Organization
Organization Name:VILLAGE OF BELOIT
Other - Org Name:BELOIT VOL F.D. RESCUE SQUAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-525-7278
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-0276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17893 EAST FIFTH ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:OH
Practice Address - Zip Code:44609
Practice Address - Country:US
Practice Address - Phone:330-938-9305
Practice Address - Fax:330-938-9305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLAGE OF BELOIT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020320250341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH590013819OtherRR MEDICARE
OH0475632Medicaid
OH000000252909OtherANTHEM BCBS
OH590013819OtherRR MEDICARE
OH=========006OtherMEDICAL MUTUAL