Healthcare Provider Details

I. General information

NPI: 1063650745
Provider Name (Legal Business Name): SOUTH WEBSTER/ BLOOM TOWNSHIP JOINT FIRE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MARKET STREET
SOUTH WEBSTER OH
45682
US

IV. Provider business mailing address

PO BOX 593
AKRON OH
44309-0593
US

V. Phone/Fax

Practice location:
  • Phone: 330-836-9150
  • Fax: 330-836-6205
Mailing address:
  • Phone: 330-836-9150
  • Fax: 330-836-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELLIS COOK
Title or Position: CHIEF
Credential:
Phone: 740-778-2263