Provider Demographics
NPI:1225083793
Name:SUGAR GROVE VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:SUGAR GROVE VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS LEADER/TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-489-7852
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:16350-0338
Mailing Address - Country:US
Mailing Address - Phone:814-489-7852
Mailing Address - Fax:814-489-5443
Practice Address - Street 1:11 WILSON ST.
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:PA
Practice Address - Zip Code:16350
Practice Address - Country:US
Practice Address - Phone:814-489-7852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015682140001Medicaid
PA424828OtherHEALTH ASSURANCE/HEALTH AMERICA
590008807Medicare PIN
PA424828OtherHEALTH ASSURANCE/HEALTH AMERICA