Brookside Volunteer Fire Department

Primary specialty

AmbulanceTaxonomy code 341600000X

License

020326200 Issued in OH

Legal business name

BROOKSIDE VOLUNTEER FIRE DEPARTMENT

Practice address

875 National Rd
Bridgeport, OH 43912-1464

Phone

(740) 635-1997

NPI assigned

May 17, 2006

Organization subpart

No

Name

Allen G Ketzell III

Title

Chief

Phone

(740) 635-1997

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, last updated by the provider on Feb 5, 2024.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1497707491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 NATIONAL RD",
            "city": "BRIDGEPORT",
            "state": "OH",
            "postal_code": "439121464",
            "telephone_number": "740-635-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 NATIONAL RD",
            "city": "BRIDGEPORT",
            "state": "OH",
            "postal_code": "439121464",
            "telephone_number": "740-635-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE VOLUNTEER FIRE DEPARTMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "KETZELL",
        "authorized_official_first_name": "ALLEN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "740-635-1997",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "OH",
            "license": "020326200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MTSTATE",
            "identifier": "001705145",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMEDICARE",
            "identifier": "590012039",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000278014",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2072395",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kennedi Boone, BCBA
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• All providers in Bridgeport, OH
• Ambulance in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.