1962422550 NPI number — FELLOWS CLUB VOLUNTEER FIRE DEPT

Table of content: (NPI 1962422550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962422550 NPI number — FELLOWS CLUB VOLUNTEER FIRE DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FELLOWS CLUB 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's Other Name Information

Provider Other Organization Name:
FELLOWS CLUB AMBULANCE SERVICE
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:
1962422550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONNEAUTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16406-0305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-587-2876
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 STRAWBERRY ALLEY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNEAUTVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-587-2876
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARLESS
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
F
Authorized Official Title or Position:
TREASURER/AMBULANCE CHIEF
Authorized Official Telephone Number:
814-587-2876

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: 336903 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50149 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015664520003 . This is a "ION HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0015664520003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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