# POLK JACKSON PERRY VOLUNTEER FIREFIGHTERS & SQUADPERSONS ASSICI

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Polk Jackson Perry Fire District
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114919081
- **Authorized official:** KATHLEEN WILEY (FISCAL OFFICER)
- **Authorized official phone:** (419) 945-2681

## Contact information

- **Practice address:** 209 E CONGRESS ST, POLK, OH 44866-9701
- **Practice address phone:** (419) 945-2681
- **Mailing address:** PO BOX 392907, PITTSBURGH, PA 15251-9907
- **Mailing address phone:** (800) 962-1484
- **Mailing address fax:** (513) 772-4464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416L0300X | Land Ambulance | 020363050 | OH | Yes |

## Other

- **Enumeration date:** 08/17/2005
- **Last updated:** 05/14/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000272999 | ANTHEM | OH |
| 05 | — | 2385333 | — | OH |