1265579353 NPI number — QUEENSTOWN VOLUNTEER FIRE DEPARTMENT INC

Table of content: (NPI 1265579353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265579353 NPI number — QUEENSTOWN VOLUNTEER FIRE DEPARTMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEENSTOWN VOLUNTEER FIRE DEPARTMENT INC
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:
1265579353
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUEENSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21658-0118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-827-8377
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7110 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-827-8377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLDERSHAW
Authorized Official First Name:
TAYLOR
Authorized Official Middle Name:
Authorized Official Title or Position:
CAPTAIN
Authorized Official Telephone Number:
443-988-1723

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: 86JF . This is a "CAREFIRST BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 181311 . This is a "HEALTH AMERICA/ASSURANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 414078800 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: N601 . This is a "FEDERAL BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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