=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487649745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF EATON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2005
-----------------------------------------------------
Last Update Date | 11/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 328 N MAPLE ST
-----------------------------------------------------
City | EATON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45320-1830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-456-5310
-----------------------------------------------------
Fax | 937-456-5311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 645198
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45264-5198
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-631-2658
-----------------------------------------------------
Fax | 937-291-2971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | BRIAN SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-456-5310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 02035880013
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------