Provider Demographics
NPI:1316089105
Name:WOLFHURST CENTRAL VOLUNTEER FIRE DEPARTMENT
Entity type:Organization
Organization Name:WOLFHURST CENTRAL VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:ICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-635-3192
Mailing Address - Street 1:55485 BRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-1547
Mailing Address - Country:US
Mailing Address - Phone:740-635-3192
Mailing Address - Fax:
Practice Address - Street 1:55485 BRAND AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:OH
Practice Address - Zip Code:43954
Practice Address - Country:US
Practice Address - Phone:740-635-3192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020324800341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00074611OtherRR MEDICARE
OH2072000Medicaid
OH000000288061OtherBCBS
OH=========00OtherBWC
OH2072000Medicaid
OH00074611OtherRR MEDICARE