Allen Clay Joint Fire District
Organization Active NPI Land Ambulance · Genoa, OH
NPI 1891748893 · NPPES record last updated Dec 23, 2019
Key facts
- NPI
- 1891748893
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- Legal business name
- ALLEN CLAY JOINT FIRE DISTRICT
- Practice address
- 3155 N. Genoa Clay Center Rd
Genoa, OH 43430-9464 - Phone
- (419) 855-4733
- Fax
- (419) 855-1074
- NPI assigned
- May 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Timothy Musolf, PARAMEDIC
- Title
- Fire Chief
- Phone
- (419) 855-4733
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100616000242 | OH | Part B Supplier - Ambulance Service Supplier | 2365572419 | Practice locations: Genoa, OH; Williston, OH |
National Provider Directory
Locations
101 E 6th St
Genoa, OH 43430
Phone (419) 855-4733
3155 N Genoa Clay Center Rd
Genoa, OH 43430
Phone (419) 855-4733
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulance | 341600000X | |||
| Land Ambulance | 3416L0300X | Yes |
Addresses
Primary practice location
3155 N. Genoa Clay Center Rd
Genoa, OH 43430-9464
Mailing address
PO Box 21727
Cleveland, OH 44121-0727
Phone (440) 605-9117
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2266604 | Medicaid | OH | |
| 000000203042 | Other | OH | ANTHEM BCBS |
| 590014700 | Other | OH | RAILROAD MEDICARE |
Other providers in Genoa, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.