Healthcare Provider Details

I. General information

NPI: 1265433056
Provider Name (Legal Business Name): CITY OF FAIRBORN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 HEBBLE AVE.
FAIRBORN OH
45324
US

IV. Provider business mailing address

PO BOX 643729
CINCINNATI OH
45264-0309
US

V. Phone/Fax

Practice location:
  • Phone: 937-754-3080
  • Fax: 937-879-2201
Mailing address:
  • Phone: 937-754-3080
  • Fax: 937-879-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: RYAN WILLIAMS
Title or Position: FIRE CHIEF
Credential:
Phone: 937-754-3080