1619030038 NPI number — WATER WITCH FIRE COMPANY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619030038 NPI number — WATER WITCH FIRE COMPANY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATER WITCH FIRE COMPANY 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:
1619030038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 324
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT DEPOSIT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21904-0324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-378-4223
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT DEPOSIT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21904-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-378-4223
Provider Business Practice Location Address Fax Number:
410-378-9343
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TOME
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AMBULANCE CHIEF
Authorized Official Telephone Number:
410-378-4223

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: R139 . This is a "FEDERAL BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 72576 . This is a "HEALTH AMERICA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 389998500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: Z863 . This is a "CAREFIRST BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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