Provider Demographics
NPI:1104823871
Name:RALSTON VOLUNTEER FIRE COMPANY INC
Entity Type:Organization
Organization Name:RALSTON VOLUNTEER FIRE COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY, AMBULANCE CAPTAIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:570-995-5555
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:PA
Mailing Address - Zip Code:17763-0001
Mailing Address - Country:US
Mailing Address - Phone:570-995-5555
Mailing Address - Fax:570-995-9118
Practice Address - Street 1:10970 RT 14
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:PA
Practice Address - Zip Code:17763-0001
Practice Address - Country:US
Practice Address - Phone:570-995-5555
Practice Address - Fax:570-995-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017009250003Medicaid
PA808283OtherBLUE CROSS/BLUE SHIELD
PA808283OtherBLUE CROSS/BLUE SHIELD