1215917828 NPI number — FIRE DEPARTMENT OF NORTH VERSAILLES

Table of content: (NPI 1215917828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215917828 NPI number — FIRE DEPARTMENT OF NORTH VERSAILLES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRE DEPARTMENT OF NORTH VERSAILLES
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:
FIRE DEPARTMENT OF NORTH VERSAILLES EMS
Provider Other Organization Name Type Code:
3
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:
1215917828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 220
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH VERSAILLES
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15137-0220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-829-7378
Provider Business Mailing Address Fax Number:
412-200-5615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1021 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH VERSAILLES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15137-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-829-7378
Provider Business Practice Location Address Fax Number:
412-200-5615
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTON
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
412-829-7378

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03077 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0010400920003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590014680 . This is a "RRMEDICARE/PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 218247 . This is a "UMPC HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 239725 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 106607500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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