1245399286 NPI number — NEWPORT TOWNSHIP FIREMEN'S COMMUNITY

Table of content: (NPI 1245399286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245399286 NPI number — NEWPORT TOWNSHIP FIREMEN'S COMMUNITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWPORT TOWNSHIP FIREMEN'S COMMUNITY
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:
1245399286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 CENTER ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NANTICOKE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18634-1904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-735-4652
Provider Business Mailing Address Fax Number:
570-735-4652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 CENTER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NANTICOKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18634-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-735-4652
Provider Business Practice Location Address Fax Number:
570-735-4652
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FLORYSHAK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-735-4652

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: P036777 . This is a "CHAMPVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 833937 . This is a "FEDERAL BLACK LUNG" identifier . This identifiers is of the category "OTHER".




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