Provider Demographics
NPI:1376546093
Name:SECOND ALARMER'S ASSN & RESCUE SQUAD OF MONTGOMERY COUNTY INC
Entity Type:Organization
Organization Name:SECOND ALARMER'S ASSN & RESCUE SQUAD OF MONTGOMERY COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-659-1885
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-0013
Mailing Address - Country:US
Mailing Address - Phone:215-659-1885
Mailing Address - Fax:215-659-3177
Practice Address - Street 1:307 DAVISVILLE RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-3322
Practice Address - Country:US
Practice Address - Phone:215-659-1885
Practice Address - Fax:215-659-3177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA13-0025146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010508300003Medicaid
PA280868Medicare PIN