Provider Demographics
NPI:1699046318
Name:SOUTH CENTRAL FIRE DISTRICT
Entity type:Organization
Organization Name:SOUTH CENTRAL FIRE DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-695-9919
Mailing Address - Street 1:288 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44627-9594
Mailing Address - Country:US
Mailing Address - Phone:330-695-9919
Mailing Address - Fax:330-695-9919
Practice Address - Street 1:288 N MILL ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:OH
Practice Address - Zip Code:44627-9594
Practice Address - Country:US
Practice Address - Phone:330-695-9919
Practice Address - Fax:330-695-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020708700341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074709Medicaid
OH=========OtherANTHEM BCBS
OHH123950Medicare PIN