Provider Demographics
NPI:1144228354
Name:KENTON COMMUNITY VOLUTNEER FIRE DEPARTMENT INC
Entity type:Organization
Organization Name:KENTON COMMUNITY VOLUTNEER FIRE DEPARTMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIZZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-356-3434
Mailing Address - Street 1:10361 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1220
Mailing Address - Country:US
Mailing Address - Phone:800-962-1484
Mailing Address - Fax:
Practice Address - Street 1:14081 DECOURSEY PIKE
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:KY
Practice Address - Zip Code:41063
Practice Address - Country:US
Practice Address - Phone:859-356-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1474341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0328103Medicaid
WV3110021370OtherWV WORKERS COMP
KY56031388Medicaid
KY55001416Medicaid
KYP00657887OtherRAILROAD MEDICARE
KY000000378825OtherANTHEM
KY56031388Medicaid
KY8055001Medicare PIN