Provider Demographics
NPI:1245281427
Name:CUMBERLAND TRAIL FIRE DISTRICT NO 4
Entity type:Organization
Organization Name:CUMBERLAND TRAIL FIRE DISTRICT NO 4
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-695-5147
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:ST CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-0505
Mailing Address - Country:US
Mailing Address - Phone:740-695-5147
Mailing Address - Fax:740-695-6630
Practice Address - Street 1:142 S MARIETTA ST
Practice Address - Street 2:
Practice Address - City:ST CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1113
Practice Address - Country:US
Practice Address - Phone:740-695-5147
Practice Address - Fax:740-695-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020321551341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020321550OtherBOARD OF PHARMACY
OH590005867OtherRAILROAD MEDICARE
OH000212164OtherMT. STATE
OH892909OtherBLACK LUNG
OH000000155729OtherBCBS
OH0791933Medicaid
OH0791933Medicaid