Provider Demographics
NPI:1023058807
Name:TOWN & COUNTRY FIRE DISTRICT
Entity type:Organization
Organization Name:TOWN & COUNTRY FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:419-853-4022
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44287-0175
Mailing Address - Country:US
Mailing Address - Phone:419-853-4022
Mailing Address - Fax:419-853-1305
Practice Address - Street 1:60 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:OH
Practice Address - Zip Code:44287
Practice Address - Country:US
Practice Address - Phone:419-853-4022
Practice Address - Fax:419-853-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020726450341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9307031Medicare PIN