Provider Demographics
NPI:1073724738
Name:MONTGOMERY VOLUNTEER FIRE CO
Entity Type:Organization
Organization Name:MONTGOMERY VOLUNTEER FIRE CO
Other - Org Name:MONTGOMERY VOL FIRE CO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AMBULANCE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MAGYAR
Authorized Official - Suffix:
Authorized Official - Credentials:NREMP-P
Authorized Official - Phone:570-547-6731
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:24 MONTGOMERY ST.
Mailing Address - City:MONTGOMERY
Mailing Address - State:PA
Mailing Address - Zip Code:17752
Mailing Address - Country:US
Mailing Address - Phone:570-547-1380
Mailing Address - Fax:570-547-1381
Practice Address - Street 1:24 MONTGOMERY ST.
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:PA
Practice Address - Zip Code:17752
Practice Address - Country:US
Practice Address - Phone:570-547-1380
Practice Address - Fax:570-547-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA41007146N00000X
PA4100701341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
No341600000XTransportation ServicesAmbulanceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012688170001Medicaid
PA200484Medicare ID - Type Unspecified