MEDICARE: TOWN & COUNTRY FIRE DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	020726450	OH

General Provider Information

NPI Number	:	1023058807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN & COUNTRY FIRE DISTRICT

Provider Business Mailing Address
First Line	:	PO BOX 175
Second Line	:
City	:	WEST SALEM
State	:	OH
Zip	:	44287-0175
Country	:	US
Telephone Number	:	419-853-4022
Fax Number	:	419-853-1305

Provider Business Practice Location Address
First Line	:	60 N LINCOLN ST
Second Line	:
City	:	WEST SALEM
State	:	OH
Zip	:	44287
Country	:	US
Telephone Number	:	419-853-4022
Fax Number	:	419-853-1305

Authorized Official
Title or Position	:	FISCAL OFFICER
Name	:	DAVID W FUNK JR.
Credential	:
Telephone Number	:	419-853-4022

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/14/2022

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Directions to “TOWN & COUNTRY FIRE DISTRICT ” Practice Location

Language	Start Address	Practice Location

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