MEDICARE: LICKING TWP EMERGENCY SQUAD AND FIRE DEPT 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	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821206491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LICKING TWP EMERGENCY SQUAD AND FIRE DEPT INC

Provider Business Mailing Address
First Line	:	PO BOX 67
Second Line	:
City	:	NASHPORT
State	:	OH
Zip	:	43830-0067
Country	:	US
Telephone Number	:	740-453-1888
Fax Number	:	740-450-8617

Provider Business Practice Location Address
First Line	:	6705 DILLON HILLS DR
Second Line	:
City	:	NASHPORT
State	:	OH
Zip	:	43830-9798
Country	:	US
Telephone Number	:	740-453-1888
Fax Number	:	740-450-8617

Authorized Official
Title or Position	:	EMS LIEUTENANT
Name	:	SPENCER BELL
Credential	:
Telephone Number	:	740-453-1888

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	02/13/2023

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