1821010331 NPI number — SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1

Table of content: (NPI 1821010331)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821010331 NPI number — SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 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:
1821010331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1923 SLOCUM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAPWALLOPEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18660-8886
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-868-6255
Provider Business Mailing Address Fax Number:
570-868-3815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1923 SLOCUM 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:
18660-8886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-868-6255
Provider Business Practice Location Address Fax Number:
570-868-3815
Provider Enumeration Date:
07/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WIATEROWSKI
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EMS CAPTAIN/BILLING OFFICER
Authorized Official Telephone Number:
570-868-6255

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: 083364100 . This is a "FEDERAL BLACK LUNG PROG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 248702 . This is a "HIGHMARK BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 998571 . This is a "BLUE CROSS NEPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011294690001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".