1073724738 NPI number — MONTGOMERY VOLUNTEER FIRE CO

Table of content: (NPI 1073724738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073724738 NPI number — MONTGOMERY VOLUNTEER FIRE CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY VOLUNTEER FIRE CO
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:
MONTGOMERY VOL FIRE CO
Provider Other Organization Name Type Code:
4
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:
1073724738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 76
Provider Second Line Business Mailing Address:
24 MONTGOMERY ST.
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-547-1380
Provider Business Mailing Address Fax Number:
570-547-1381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 MONTGOMERY ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-547-1380
Provider Business Practice Location Address Fax Number:
570-547-1381
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAGYAR
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
AMBULANCE CAPTAIN
Authorized Official Telephone Number:
570-547-6731

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , with the licence number:  41007 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 341600000X , with the licence number: 4100701 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0012688170001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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