| Organization Name: | POLK JACKSON PERRY VOLUNTEER FIREFIGHTERS & SQUADPERSONS ASSICI |
| NPI Number: | 1114919081 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHLEEN WILEY (FISCAL OFFICER) |
| Mailing Address: | 209 E Congress St Polk |
| State: | OH US |
| Postal Code: | 448669701 |
| Phone Number: | 4199452681 |
| Fax Number: | |
| NPI Enumeration Date: | 08/17/2005 |
| NPI Last Update Date: | 08/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 3416L0300X |
| License Number: | 020363050 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Transportation Services |
| Taxonomy Classification: | Ambulance |
| Taxonomy Specialization: | Land Transport |
| Taxonomy Definition: | |