Provider Demographics
NPI:1437134616
Name:PLUNKETTS CREEK TOWNSHIP FIRE DEPARTMENT
Entity Type:Organization
Organization Name:PLUNKETTS CREEK TOWNSHIP FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE DEPARTMENT PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-435-3236
Mailing Address - Street 1:700 HIGH ST
Mailing Address - Street 2:C/O WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3100
Mailing Address - Country:US
Mailing Address - Phone:570-321-2003
Mailing Address - Fax:570-321-2263
Practice Address - Street 1:327 DUNWOODY RD
Practice Address - Street 2:C/O AMBULANCE
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-8658
Practice Address - Country:US
Practice Address - Phone:570-478-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033483416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019687080002Medicaid
=========OtherCOMMERICAL PAYORS
PA0019687080002Medicaid
590014339Medicare ID - Type UnspecifiedRAILROAD MEDICARE NUMBER