Healthcare Provider Details

I. General information

NPI: 1366434821
Provider Name (Legal Business Name): JEROMESVILLE FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTH ST
JEROMESVILLE OH
44840-9783
US

IV. Provider business mailing address

PO BOX 951953
CLEVELAND OH
44193-0021
US

V. Phone/Fax

Practice location:
  • Phone: 419-368-6811
  • Fax:
Mailing address:
  • Phone: 937-619-3013
  • Fax: 937-619-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateOH

VIII. Authorized Official

Name: MAX FULK
Title or Position: CHIEF
Credential:
Phone: 419-368-6811