Provider Demographics
NPI:1174709471
Name:SUDLERSVILLE FIRE COMPANY INCORPORATED
Entity type:Organization
Organization Name:SUDLERSVILLE FIRE COMPANY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:FAUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-438-3155
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:SUDLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21668-0061
Mailing Address - Country:US
Mailing Address - Phone:410-438-3155
Mailing Address - Fax:
Practice Address - Street 1:203 NORTH CHURCH ST.
Practice Address - Street 2:
Practice Address - City:SUDLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21668
Practice Address - Country:US
Practice Address - Phone:410-438-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD29776OtherHEALTH AMERICA
MDTR17SUOtherCAREFIRST BLUE CROSS
MD440900100Medicaid
590011284Medicare PIN
MD440900100Medicaid