=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699046318
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH CENTRAL FIRE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2012
-----------------------------------------------------
Last Update Date | 07/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 288 N MILL ST
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44627-9594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-695-9919
-----------------------------------------------------
Fax | 330-695-9919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 288 N MILL ST
-----------------------------------------------------
City | FREDERICKSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44627-9594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-695-9919
-----------------------------------------------------
Fax | 330-695-9919
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FISCAL OFFICER
-----------------------------------------------------
Name | MR. SHAWN MCKELVEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-695-9919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 020708700
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------