Provider Demographics
NPI:1194764258
Name:HOLLOWAY VOLUNTEER FIRE DEPARTMENT, INC
Entity type:Organization
Organization Name:HOLLOWAY VOLUNTEER FIRE DEPARTMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS BILLING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-968-4260
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:HOLLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43985-0176
Mailing Address - Country:US
Mailing Address - Phone:740-968-0504
Mailing Address - Fax:740-968-0504
Practice Address - Street 1:108 W. MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43985
Practice Address - Country:US
Practice Address - Phone:740-968-0504
Practice Address - Fax:740-968-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020376600341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2914896Medicaid
OHP00751293OtherRR MEDICARE
OH2914896Medicaid
OH2914896Medicaid