Provider Demographics
NPI:1902888290
Name:BAZETTA TOWNSHIP TRUSTEES
Entity Type:Organization
Organization Name:BAZETTA TOWNSHIP TRUSTEES
Other - Org Name:BAZETTA TOWNSHIP FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:S
Authorized Official - Last Name:RINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-637-4136
Mailing Address - Street 1:3372 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1627
Mailing Address - Country:US
Mailing Address - Phone:330-637-8816
Mailing Address - Fax:330-637-4588
Practice Address - Street 1:3000 WARREN MEADVILLE RD
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9322
Practice Address - Country:US
Practice Address - Phone:330-637-4136
Practice Address - Fax:330-638-4193
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAZETTA TOWNSHIP TRUSTEES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-14
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020833950341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155329OtherBCBS
OH0793539Medicaid
OH1547466OtherGATEWAY CARE-CAID
OH1547466OtherGATEWAY CARE-CAID
OH=========01OtherBWC
OH=========01OtherBWC