Healthcare Provider Details

I. General information

NPI: 1568444859
Provider Name (Legal Business Name): BURGHILL-VERNON VOLUNTEER FIRE DEPARTMENT ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6915 STATE ROUTE 88
KINSMAN OH
44428-9790
US

IV. Provider business mailing address

6915 B STATE ROUTE 88
KINSMAN OH
44428-9790
US

V. Phone/Fax

Practice location:
  • Phone: 330-772-3013
  • Fax: 330-772-2874
Mailing address:
  • Phone: 330-448-6220
  • Fax: 330-448-6220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DENISE M MOTT
Title or Position: BILLING CLERK
Credential:
Phone: 330-448-6220