Provider Demographics
NPI:1417093154
Name:MILMONT FIRE CO 1
Entity Type:Organization
Organization Name:MILMONT FIRE CO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CAPTAIN
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:610-532-3232
Mailing Address - Street 1:PO BOX 42973
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101
Mailing Address - Country:US
Mailing Address - Phone:610-532-9444
Mailing Address - Fax:610-532-9911
Practice Address - Street 1:714 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:PA
Practice Address - Zip Code:19033-3503
Practice Address - Country:US
Practice Address - Phone:610-532-3232
Practice Address - Fax:610-532-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA044704341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016403260001Medicaid
PA1417093154OtherRAILROAD MEDICARE
PA1417093154OtherRAILROAD MEDICARE