1639220593 NPI number — WEST END FIRE COMPANY NO 3 OF PHOENIXVILLE

Table of content: (NPI 1639220593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639220593 NPI number — WEST END FIRE COMPANY NO 3 OF PHOENIXVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST END FIRE COMPANY NO 3 OF PHOENIXVILLE
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:
6
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:
1639220593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 726
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CUMBERLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17070-0726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-724-4136
Provider Business Mailing Address Fax Number:
717-635-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIXVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19460-4214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-933-5160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STALEY
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
LIEUTENANT
Authorized Official Telephone Number:
610-933-1140

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  06037 , 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: 1011699 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009463860003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116429700 . This is a "DEPT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590939012 . This is a "PALMETTO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0027011000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 31815 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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