MEDICARE: L-A JOINT 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	3416L0300X	Land Ambulance	OH PHARMACY BOARD	OH

General Provider Information

NPI Number	:	1326367186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L-A JOINT FIRE DISTRICT

Provider Business Mailing Address
First Line	:	836 4TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-1407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	223 LOCK STREET
Second Line	:
City	:	LOWELL
State	:	OH
Zip	:	45744
Country	:	US
Telephone Number	:	740-896-3110
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. BOB KUBOTA
Credential	:
Telephone Number	:	740-896-3110

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	11/29/2017

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Directions to “L-A JOINT FIRE DISTRICT ” Practice Location

Language	Start Address	Practice Location

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