Provider Demographics
NPI:1245263482
Name:1ST CONSOLIDATED FIRE DISTRICT
Entity type:Organization
Organization Name:1ST CONSOLIDATED FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTERBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-845-3332
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:513-772-4464
Practice Address - Street 1:115 N HIGH ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:OH
Practice Address - Zip Code:43314-7717
Practice Address - Country:US
Practice Address - Phone:419-845-3332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0203634503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00247200OtherRAILROAD MEDICARE
OH000000360582OtherANTHEM
OH2235727Medicaid
OH2235727Medicaid
OH=========00OtherBUREAU OF WORKERS COMP
OH=========004OtherMEDICAL MUTUAL OF OHIO