Healthcare Provider Details

I. General information

NPI: 1891748893
Provider Name (Legal Business Name): ALLEN CLAY JOINT FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 N. GENOA CLAY CENTER RD
GENOA OH
43430-9464
US

IV. Provider business mailing address

PO BOX 21727
CLEVELAND OH
44121-0727
US

V. Phone/Fax

Practice location:
  • Phone: 419-855-4733
  • Fax: 419-855-1074
Mailing address:
  • Phone: 440-605-9117
  • Fax: 440-442-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL TIMOTHY MUSOLF
Title or Position: FIRE CHIEF
Credential: PARAMEDIC
Phone: 419-855-4733