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General NPI Number Information
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NPI Number | 1316089105
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Entity Type | Organization
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Legal Business Name | WOLFHURST CENTRAL VOLUNTEER FIRE DEPARTMENT
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 55485 BRAND AVE
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City | LANSING
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State | OH
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Zip | 43954
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Country | US
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Telephone | 740-635-3192
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Fax |
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Provider Business Mailing Address
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Address Line | 55485 BRAND AVE
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City | BRIDGEPORT
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State | OH
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Zip | 43912-1547
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Country | US
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Telephone | 740-635-3192
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT S ICE
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Credential |
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Telephone | 740-635-3192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 020324800
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License Number State | OH
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