Provider Demographics
NPI:1114023389
Name:SILVER LAKE VOLUNTEER FIRE COMPANY
Entity Type:Organization
Organization Name:SILVER LAKE VOLUNTEER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT COMMANDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-237-3891
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:BRACKNEY
Mailing Address - State:PA
Mailing Address - Zip Code:18812-0133
Mailing Address - Country:US
Mailing Address - Phone:570-663-2102
Mailing Address - Fax:570-663-2888
Practice Address - Street 1:3417 QUAKER LAKE RD
Practice Address - Street 2:
Practice Address - City:BRACKNEY
Practice Address - State:PA
Practice Address - Zip Code:18812-0133
Practice Address - Country:US
Practice Address - Phone:570-663-2102
Practice Address - Fax:570-663-2888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2013-04-25
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA998529OtherBC OF NEPA
PA1445479OtherHIGHMARK BLUE SHIELD
PA816549OtherFIRST PRIORITY HEALTH
PA0027651918001Medicaid
PA065182Medicare PIN