1447246418 NPI number — FAIRVIEW FIRE CO 1

Table of content: (NPI 1447246418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447246418 NPI number — FAIRVIEW FIRE CO 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW FIRE CO 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:
1447246418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 W PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COAL TWP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17866
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-648-1700
Provider Business Mailing Address Fax Number:
570-648-1490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 W PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COAL TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-648-1700
Provider Business Practice Location Address Fax Number:
570-648-1490
Provider Enumeration Date:
09/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STRAUSSER
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
570-648-1700

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: 208433 . This is a "BCBS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 083209100 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 208433 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011206580001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".