Provider Demographics
NPI:1235105362
Name:ST THOMAS TOWNSHIP VOLUNTEER FIRE & RESCUE CO. INC.
Entity Type:Organization
Organization Name:ST THOMAS TOWNSHIP VOLUNTEER FIRE & RESCUE CO. INC.
Other - Org Name:ST THOMAS AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:717-369-2946
Mailing Address - Street 1:4 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHIREMANSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17011-6326
Mailing Address - Country:US
Mailing Address - Phone:717-920-8420
Mailing Address - Fax:717-901-5731
Practice Address - Street 1:34 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:PA
Practice Address - Zip Code:17252
Practice Address - Country:US
Practice Address - Phone:717-369-2946
Practice Address - Fax:717-369-5683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA012930790005Medicaid
PA281270Medicare ID - Type Unspecified