MEDICARE: BROOKSIDE VOLUNTEER FIRE DEPARTMENT

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	020326200	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	590012039	OTHER	OH	RRMEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001705145	OTHER	OH	MTSTATE
3	000000278014	OTHER	OH	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497707491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKSIDE VOLUNTEER FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	875 NATIONAL RD
Second Line	:
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-1464
Country	:	US
Telephone Number	:	740-635-1997
Fax Number	:

Provider Business Practice Location Address
First Line	:	875 NATIONAL RD
Second Line	:
City	:	BRIDGEPORT
State	:	OH
Zip	:	43912-1464
Country	:	US
Telephone Number	:	740-635-1997
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	ALLEN G KETZELL III
Credential	:
Telephone Number	:	740-635-1997

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/05/2024

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Directions to “BROOKSIDE VOLUNTEER FIRE DEPARTMENT ” Practice Location

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