Provider Demographics
NPI:1053466995
Name:TRAINER FIRE COMPANY
Entity Type:Organization
Organization Name:TRAINER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-368-7602
Mailing Address - Street 1:PO BOX 42973
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101
Mailing Address - Country:US
Mailing Address - Phone:610-532-9444
Mailing Address - Fax:610-532-9911
Practice Address - Street 1:3529 W 3RD STREET
Practice Address - Street 2:
Practice Address - City:TRAINER
Practice Address - State:PA
Practice Address - Zip Code:19061-5109
Practice Address - Country:US
Practice Address - Phone:610-494-8711
Practice Address - Fax:610-494-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03337341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590006807OtherPALMETTO GBA RR MEDICARE
PA0033277000OtherIBC
PA0017535620001Medicaid
PA590006807OtherPALMETTO GBA RR MEDICARE
PA0787642Medicare ID - Type Unspecified