1285289785 NPI number — BERLIN FIRE COMPANY EMERGENCY MEDICAL SERVICES INC

Table of content: (NPI 1285289785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285289785 NPI number — BERLIN FIRE COMPANY EMERGENCY MEDICAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERLIN FIRE COMPANY EMERGENCY MEDICAL SERVICES 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:
1285289785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W COMMONS BLVD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
NEW CASTLE
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19720-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-456-5725
Provider Business Mailing Address Fax Number:
888-456-3155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 N MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21811-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-479-4790
Provider Business Practice Location Address Fax Number:
410-479-4793
Provider Enumeration Date:
08/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FITZGERALD
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-641-1977

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: 768011200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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