1427127307 NPI number — OKLAHOMA VOL FIRE DEPT #1

Table of content: (NPI 1427127307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427127307 NPI number — OKLAHOMA VOL FIRE DEPT #1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OKLAHOMA VOL FIRE DEPT #1
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:
1427127307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142
Provider Second Line Business Mailing Address:
130 WASHINGTON RD
Provider Business Mailing Address City Name:
APOLLO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15613-0142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-727-3955
Provider Business Mailing Address Fax Number:
724-727-3953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH APOLLO
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15673-0787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-727-3955
Provider Business Practice Location Address Fax Number:
724-727-3953
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FETTERMAN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-727-3952

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  06051 , 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: 803266 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05088311 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8122 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 66979 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007007420001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018626 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: V0V212 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 292043 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".




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