Provider Demographics
NPI:1073511499
Name:GOOD WILL FIRE COMPANY NO 1 OF MINERSVILLE
Entity Type:Organization
Organization Name:GOOD WILL FIRE COMPANY NO 1 OF MINERSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-544-6099
Mailing Address - Street 1:25 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MINERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17954-1400
Mailing Address - Country:US
Mailing Address - Phone:570-544-9635
Mailing Address - Fax:570-544-9634
Practice Address - Street 1:25 NORTH ST
Practice Address - Street 2:
Practice Address - City:MINERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17954-1400
Practice Address - Country:US
Practice Address - Phone:570-544-9635
Practice Address - Fax:570-544-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-09
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3416L0300X
PA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012546150004Medicaid
PA284283Medicare PIN