Provider Demographics
NPI:1033388335
Name:ROULETTE CHEMICAL ENGINE CO #1 INC
Entity Type:Organization
Organization Name:ROULETTE CHEMICAL ENGINE CO #1 INC
Other - Org Name:ROULETTE AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FILLHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-755-8153
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:ROULETTE
Mailing Address - State:PA
Mailing Address - Zip Code:16746-0172
Mailing Address - Country:US
Mailing Address - Phone:814-544-7762
Mailing Address - Fax:814-544-7495
Practice Address - Street 1:12 RIVER ST
Practice Address - Street 2:
Practice Address - City:ROULETTE
Practice Address - State:PA
Practice Address - Zip Code:16746-0172
Practice Address - Country:US
Practice Address - Phone:814-544-7762
Practice Address - Fax:814-544-7495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNKNOWN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA606023416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport