Healthcare Provider Details

I. General information

NPI: 1467423236
Provider Name (Legal Business Name): JEROMESVILLE FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTH HURON STREET
JEROMESVILLE OH
44840-0414
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 419-368-6811
  • Fax: 419-368-4147
Mailing address:
  • Phone: 800-336-6402
  • Fax: 860-563-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number020736400
License Number StateOH

VIII. Authorized Official

Name: MRS. MARY T GENTILE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 860-257-7080