Provider Demographics
NPI:1447569728
Name:TRUCKSVILLE VOLUNTEER EMS FIRE & RESCUE ASSOCIATION
Entity Type:Organization
Organization Name:TRUCKSVILLE VOLUNTEER EMS FIRE & RESCUE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-696-3776
Mailing Address - Street 1:11 CARVERTON RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1752
Mailing Address - Country:US
Mailing Address - Phone:570-696-3776
Mailing Address - Fax:
Practice Address - Street 1:200 E CENTER ST
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-1538
Practice Address - Country:US
Practice Address - Phone:570-696-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025516440001Medicaid
PA1025516440001Medicaid
PA194841Medicare PIN