1831198878 NPI number — WISSINOMING VOLUNTEER FIRST AID CORPORATION INC

Table of content: (NPI 1831198878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831198878 NPI number — WISSINOMING VOLUNTEER FIRST AID CORPORATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISSINOMING VOLUNTEER FIRST AID CORPORATION 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:
1831198878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6179 HEGERMAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19135-3711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-624-8511
Provider Business Mailing Address Fax Number:
215-332-1241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6179 HEGERMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19135-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-8511
Provider Business Practice Location Address Fax Number:
215-332-1241
Provider Enumeration Date:
07/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DICICCO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-624-8511

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  01256 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0007167890001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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