=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467423236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEROMESVILLE FIRE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2006
-----------------------------------------------------
Last Update Date | 02/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | NORTH HURON STREET
-----------------------------------------------------
City | JEROMESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44840-0414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-368-6811
-----------------------------------------------------
Fax | 419-368-4147
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 290184
-----------------------------------------------------
City | WETHERSFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06129-0184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-336-6402
-----------------------------------------------------
Fax | 860-563-3403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED AGENT
-----------------------------------------------------
Name | MRS. MARY T GENTILE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-257-7080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 020736400
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------