Provider Demographics
NPI:1255458659
Name:THE FALLSTON VOLUNTEER FIRE AND AMBULANCE COMPANY, INC.
Entity type:Organization
Organization Name:THE FALLSTON VOLUNTEER FIRE AND AMBULANCE COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-638-4890
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-0141
Mailing Address - Country:US
Mailing Address - Phone:410-638-4890
Mailing Address - Fax:
Practice Address - Street 1:2201 CARRS MILL RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047
Practice Address - Country:US
Practice Address - Phone:410-638-4890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091102000Medicaid
MDZ727THOtherCAREFIRST BLUE SHIELD
MD389QOtherMD MEDICARE
MD389QOtherCAREFIRST BLUE SHIELD
MD389QMedicare ID - Type Unspecified