Provider Demographics
NPI:1255319570
Name:SPARTANSBURG VOLUNTEER FIRE DEPT & RELIEF ASSN
Entity Type:Organization
Organization Name:SPARTANSBURG VOLUNTEER FIRE DEPT & RELIEF ASSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCOUTEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-654-7336
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:SPARTANSBURG VOL FIRE DEPT AMBULANCE SERVICE
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434-0186
Mailing Address - Country:US
Mailing Address - Phone:814-654-7336
Mailing Address - Fax:814-654-7162
Practice Address - Street 1:340 MAIN STREET
Practice Address - Street 2:SPARTANSBURG VOL FIRE DEPT AMBULANCE SERVICE
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434
Practice Address - Country:US
Practice Address - Phone:814-654-7336
Practice Address - Fax:814-654-7162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012030350002Medicaid
341659OtherHEALTH AMERICA/ASSURANCE
PA0012030350002Medicaid
590011335Medicare PIN