Provider Demographics
NPI:1801991724
Name:MANCHESTER FIREMENS BENEFIT ASSOCIATION
Entity type:Organization
Organization Name:MANCHESTER FIREMENS BENEFIT ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICK
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:937-549-3358
Mailing Address - Street 1:405 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45144-1414
Mailing Address - Country:US
Mailing Address - Phone:937-549-3358
Mailing Address - Fax:937-549-2502
Practice Address - Street 1:405 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45144-1414
Practice Address - Country:US
Practice Address - Phone:937-549-3358
Practice Address - Fax:937-549-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0041038Medicaid
OH013158Medicare UPIN
OH31187074Medicare ID - Type Unspecified