MEDICARE: ST. JOHNS VOLUNTEER FIRE & RESCUE DEPARTMENT INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	146L00000X	Paramedic	OH
2	146M00000X	Intermediate Emergency Medical Technician	OH
3	146N00000X	Basic Emergency Medical Technician
4	3416L0300X	Land Ambulance	OH

General Provider Information

NPI Number	:	1871657551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOHNS VOLUNTEER FIRE & RESCUE DEPARTMENT INC.

Provider Business Mailing Address
First Line	:	PO BOX 194
Second Line	:	13860 WALNUT STREET
City	:	SAINT JOHNS
State	:	OH
Zip	:	45884-0194
Country	:	US
Telephone Number	:	419-738-7638
Fax Number	:

Provider Business Practice Location Address
First Line	:	13860 WALNUT STREET
Second Line	:
City	:	SAINT JOHNS
State	:	OH
Zip	:	45884-0194
Country	:	US
Telephone Number	:	419-738-7638
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	MR. RODNEY CAMPBELL
Credential	:	EMT-P
Telephone Number	:	419-568-3988

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	02/19/2009

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