1922083070 NPI number — TROUT RUN VOLUNTEER FIRE COMPANY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922083070 NPI number — TROUT RUN VOLUNTEER FIRE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TROUT RUN VOLUNTEER FIRE COMPANY
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:
1922083070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 HIGH STREET
Provider Second Line Business Mailing Address:
C/O WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-321-2003
Provider Business Mailing Address Fax Number:
570-321-2263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
452 STEAM VALLEY RD
Provider Second Line Business Practice Location Address:
C/O DEBORAH A. PASSUELLO
Provider Business Practice Location Address City Name:
TROUT RUN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17771-9100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-998-8211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PASSUELLO
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
570-998-8211

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  4101416 , 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: 0007750460002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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