Provider Demographics
NPI:1114029477
Name:THE COMMUNITY FIRE COMPANY OF PERRYVILLE, MARYLAND, INC.
Entity Type:Organization
Organization Name:THE COMMUNITY FIRE COMPANY OF PERRYVILLE, MARYLAND, INC.
Other - Org Name:PERRYVILLE VOLUNTEER FIRE COMPANY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-642-2647
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21903-0417
Mailing Address - Country:US
Mailing Address - Phone:410-642-2647
Mailing Address - Fax:
Practice Address - Street 1:920 PRINCIPIO FURNACE RD
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MD
Practice Address - Zip Code:21903-2440
Practice Address - Country:US
Practice Address - Phone:410-642-2647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR923OtherFEDERAL BLUE SHIELD
MD606601100Medicaid
MDY331OtherCAREFIRST BC/BS
MD334RMedicare PIN