1114023389 NPI number — SILVER LAKE VOLUNTEER FIRE COMPANY

Table of content: (NPI 1114023389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114023389 NPI number — SILVER LAKE VOLUNTEER FIRE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER LAKE VOLUNTEER FIRE COMPANY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114023389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
08/14/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRACKNEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18812-0133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-663-2102
Provider Business Mailing Address Fax Number:
570-663-2888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3417 QUAKER LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRACKNEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18812-0133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-663-2102
Provider Business Practice Location Address Fax Number:
570-663-2888
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
ROSANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT COMMANDER
Authorized Official Telephone Number:
607-237-3891

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 998529 . This is a "BC OF NEPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1445479 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 816549 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0027651918001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".