Provider Demographics
NPI:1598766453
Name:CHARDON FIRE DEPARTMENT INC
Entity type:Organization
Organization Name:CHARDON FIRE DEPARTMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF (ASST FIRE CHIEF)
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-279-0905
Mailing Address - Street 1:PO BOX 392907
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-9907
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:
Practice Address - Street 1:110 S HAMBDEN ST
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1219
Practice Address - Country:US
Practice Address - Phone:440-285-4665
Practice Address - Fax:440-285-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
OH02037925013341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000035511OtherANTHEM
OH2064957Medicaid
OH590012150OtherRAILROAD MEDICARE
OH590012150OtherRAILROAD MEDICARE