Polk Jackson Perry Volunteer Firefighters & Squadpersons Assici

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

020363050 Issued in OH

Legal business name

POLK JACKSON PERRY VOLUNTEER FIREFIGHTERS & SQUADPERSONS ASSICI

Practice address

209 E Congress St
Polk, OH 44866-9701

Phone

(419) 945-2681

NPI assigned

Aug 17, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Wiley

Title

Fiscal Officer

Phone

(419) 945-2681

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Polk Jackson Perry Fire District Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1114919081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 392907",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152519907",
            "telephone_number": "800-962-1484",
            "fax_number": "513-772-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 E CONGRESS ST",
            "city": "POLK",
            "state": "OH",
            "postal_code": "448669701",
            "telephone_number": "419-945-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK JACKSON PERRY VOLUNTEER FIREFIGHTERS & SQUADPERSONS ASSICI",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "FISCAL OFFICER",
        "authorized_official_telephone_number": "419-945-2681"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "OH",
            "license": "020363050",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000272999",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2385333",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Polk Jackson Perry Fire District",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tana Lee Daniels, LPN
• Carla Koons, RN
• Katia Ringler, MDN, RDN, LD
• Danielle Shreve

• All providers in Polk, OH
• Land Ambulance in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.