1821091364 NPI number — HANOVER FIRE COMPANY 1

Table of content: (NPI 1821091364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821091364 NPI number — HANOVER FIRE COMPANY 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HANOVER FIRE COMPANY 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:
HEALTHSTAT MEDICAL SOLUTIONS
Provider Other Organization Name Type Code:
3
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:
1821091364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17331-0687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-848-4872
Provider Business Mailing Address Fax Number:
717-848-3871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 BALTIMORE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17331-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-848-4872
Provider Business Practice Location Address Fax Number:
717-848-3871
Provider Enumeration Date:
05/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KERNS
Authorized Official First Name:
HERMAN
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
TRUSTEE
Authorized Official Telephone Number:
717-465-1163

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: 1520047 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012030260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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