Provider Demographics
NPI:1497116909
Name:RENOVO FIRE DEPARTMENT INC
Entity Type:Organization
Organization Name:RENOVO FIRE DEPARTMENT INC
Other - Org Name:RENOVO EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:AUNGST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-923-0210
Mailing Address - Street 1:230 11TH ST
Mailing Address - Street 2:
Mailing Address - City:RENOVO
Mailing Address - State:PA
Mailing Address - Zip Code:17764-1121
Mailing Address - Country:US
Mailing Address - Phone:570-923-0210
Mailing Address - Fax:570-923-1446
Practice Address - Street 1:230 11TH ST
Practice Address - Street 2:
Practice Address - City:RENOVO
Practice Address - State:PA
Practice Address - Zip Code:17764-1121
Practice Address - Country:US
Practice Address - Phone:570-923-0210
Practice Address - Fax:570-923-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031158650001Medicaid
P01657296Medicare PIN
PA486418Medicare PIN