Healthcare Provider Details

I. General information

NPI: 1669548004
Provider Name (Legal Business Name): M&M FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S 4TH ST
MCCONNELSVILLE OH
43756-1201
US

IV. Provider business mailing address

77 S 4TH ST
MCCONNELSVILLE OH
43756-1201
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-3444
  • Fax: 740-962-4798
Mailing address:
  • Phone: 740-962-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: WAYLON CLARK
Title or Position: EMS COORD
Credential:
Phone: 740-538-4548