Provider Demographics
NPI:1366480444
Name:UTICA VOLUNTEER FIRE CO & RELIEF ASSOCIATION
Entity Type:Organization
Organization Name:UTICA VOLUNTEER FIRE CO & RELIEF ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-573-1980
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:3860 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:PA
Practice Address - Zip Code:16362-0083
Practice Address - Country:US
Practice Address - Phone:814-573-1980
Practice Address - Fax:814-425-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009139010004Medicaid
PA0009139010004Medicaid
PA289317Medicare PIN