Provider Demographics
NPI:1437319175
Name:BENTON VOLUNTEER FIRE COMPANY AMBULANCE ASSOC
Entity Type:Organization
Organization Name:BENTON VOLUNTEER FIRE COMPANY AMBULANCE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-925-5542
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-0252
Mailing Address - Country:US
Mailing Address - Phone:570-925-5542
Mailing Address - Fax:
Practice Address - Street 1:150 COLLEY ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814
Practice Address - Country:US
Practice Address - Phone:570-925-5542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022159460001Medicaid
PA108657OtherHEALTH PARTNERS
PA338913OtherHEALTH AMERICA
PA134974Medicare PIN