MEDICARE: BOLIVAR VOLUNTEER FIRE DEPARTMENT, INC.

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	020346250	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00118186	OTHER	OH	RRMEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000215790	OTHER	OH	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679659635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOLIVAR VOLUNTEER FIRE DEPARTMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 136
Second Line	:
City	:	BOLIVAR
State	:	OH
Zip	:	44612-0136
Country	:	US
Telephone Number	:	330-874-3115
Fax Number	:

Provider Business Practice Location Address
First Line	:	456 WATER STREET
Second Line	:
City	:	BOLIVAR
State	:	OH
Zip	:	44612
Country	:	US
Telephone Number	:	330-874-3115
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. SHAWN LYNCH
Credential	:
Telephone Number	:	330-874-3115

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	05/17/2011

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Directions to “BOLIVAR VOLUNTEER FIRE DEPARTMENT, INC. ” Practice Location

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