Provider Demographics
NPI:1487757449
Name:FAIRMOUNT TOWNSHIP VOLUNTEER FIRE CO NO 1
Entity type:Organization
Organization Name:FAIRMOUNT TOWNSHIP VOLUNTEER FIRE CO NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/AMBULANCE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-477-3691
Mailing Address - Street 1:671 STATE ROUTE 118
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-2039
Mailing Address - Country:US
Mailing Address - Phone:570-477-3691
Mailing Address - Fax:570-477-2487
Practice Address - Street 1:671 STATE ROUTE 118
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2039
Practice Address - Country:US
Practice Address - Phone:570-477-3691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208085OtherHIGHMARK BLUE SHIELD
PA0011295280003Medicaid
PA998548OtherBLUE CROSS OF NEPA
PA998548OtherBLUE CROSS OF NEPA
PA0011295280003Medicaid