1124059787 NPI number — WILLARDS VOLUNTEER FIRE CO INC

Table of content: (NPI 1124059787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124059787 NPI number — WILLARDS VOLUNTEER FIRE CO INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLARDS VOLUNTEER FIRE CO 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:
1124059787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLARDS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21874-0038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-479-4790
Provider Business Mailing Address Fax Number:
410-479-4793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7370 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLARDS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21874-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-479-4790
Provider Business Practice Location Address Fax Number:
410-479-4793
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
CATHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING AGENT
Authorized Official Telephone Number:
410-479-4790

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  NONE REQUIRED , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 553310400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com