Provider Demographics
NPI:1770610859
Name:DINGMAN TOWNSHIP VOLUNTEER FIRE DEPARTMENT INC.
Entity type:Organization
Organization Name:DINGMAN TOWNSHIP VOLUNTEER FIRE DEPARTMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKULAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-686-3696
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-0417
Mailing Address - Country:US
Mailing Address - Phone:610-705-3979
Mailing Address - Fax:610-705-3955
Practice Address - Street 1:680 LOG TAVERN RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7784
Practice Address - Country:US
Practice Address - Phone:570-686-3696
Practice Address - Fax:570-686-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051293416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012648900002Medicaid
PA2067631000OtherNEBC
PA590014638OtherPALMETO GBA
PA056980OtherBLUE SHIELD
PA056980Medicare ID - Type UnspecifiedMEDICARE