Organization
BROOKSIDE VOLUNTEER FIRE DEPARTMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN G KETZELL III (CHIEF)
(740) 635-1997
Entity
Organization
Contact information
Practice address
875 NATIONAL RD, BRIDGEPORT, OH 43912-1464
(740) 635-1997
Mailing address
875 NATIONAL RD, BRIDGEPORT, OH 43912-1464
(740) 635-1997
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
020326200
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000278014
BCBS
OH
01
—
001705145
MTSTATE
OH
05
—
2072395
—
OH
01
—
590012039
RRMEDICARE
OH
Enumeration date
05/17/2006
Last updated
02/05/2024
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