1508852575 NPI number — DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508852575 NPI number — DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT

Employer Identification Number (EIN):

Provider Organization Name:

DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT

Provider Last Name:

Provider First Name:

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

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:

1508852575

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

11/09/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 207

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ALLENTOWN

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

18105-0207

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

484-664-2007

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

402 SAINT JOHNS RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WAPWALLOPEN

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

18660-1627

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

570-868-5357

Provider Business Practice Location Address Fax Number:

570-868-3488

Provider Enumeration Date:

09/23/2005

Authorized Official Last Name:

KOTARSKY

Authorized Official First Name:

JEFF

Authorized Official Middle Name:

Authorized Official Title or Position:

AMBULANCE CHIEF

Authorized Official Telephone Number:

570-868-5357

• Taxonomy code: 3416L0300X , with the licence number:  04171 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0015842810002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 800577 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: P037811 . This is a "TRI CARE MID ATL" identifier . This identifiers is of the category "OTHER".
• Identifier: 290999 . This is a "BC BS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 833908 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".
• Identifier: PA43015 . This is a "PHS HEALTH PLAN HMO MDC" identifier . This identifiers is of the category "OTHER".
• Identifier: PA43015 . This is a "ACS HEALTH NET COMMERCIAL" identifier . This identifiers is of the category "OTHER".
• Identifier: 0876834 . This is a "AETNA USHC BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 290999 . This is a "BC BC OF NE PA ACCESS CAR" identifier . This identifiers is of the category "OTHER".
• Identifier: PA43015 . This is a "ACS HEALTH NET HMO MDC" identifier . This identifiers is of the category "OTHER".
• Identifier: P037811 . This is a "TRI CARE NORTHEAST" identifier . This identifiers is of the category "OTHER".
• Identifier: PA43015 . This is a "PHS HEALTH PLAN COMMERCIA" identifier . This identifiers is of the category "OTHER".
• Identifier: PA43015 . This is a "QUALMED" identifier . This identifiers is of the category "OTHER".