Provider Demographics
NPI:1215026935
Name:CHICORA INDEPENDENT HOSE COMPANY
Entity Type:Organization
Organization Name:CHICORA INDEPENDENT HOSE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-445-2220
Mailing Address - Street 1:202 WEST SLIPPERY ROCK ST
Mailing Address - Street 2:
Mailing Address - City:CHICORA
Mailing Address - State:PA
Mailing Address - Zip Code:16025-3214
Mailing Address - Country:US
Mailing Address - Phone:724-445-2220
Mailing Address - Fax:724-445-2167
Practice Address - Street 1:202 WEST SLIPPERY ROCK ST
Practice Address - Street 2:
Practice Address - City:CHICORA
Practice Address - State:PA
Practice Address - Zip Code:16025-3214
Practice Address - Country:US
Practice Address - Phone:724-445-2220
Practice Address - Fax:724-445-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060043416L0300X, 3416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010621510001Medicaid
PA0010621510001Medicaid