Provider Demographics
NPI:1508852575
Name:DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT
Entity Type:Organization
Organization Name:DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-868-5357
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:484-664-2007
Mailing Address - Fax:
Practice Address - Street 1:402 SAINT JOHNS RD
Practice Address - Street 2:
Practice Address - City:WAPWALLOPEN
Practice Address - State:PA
Practice Address - Zip Code:18660-1627
Practice Address - Country:US
Practice Address - Phone:570-868-5357
Practice Address - Fax:570-868-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041713416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015842810002Medicaid
800577OtherFIRST PRIORITY HEALTH
P037811OtherTRI CARE MID ATL
290999OtherBC BS OF PA BLUE SHIELD
833908OtherUMWA HEALTH & RETIREMENT
PA43015OtherPHS HEALTH PLAN HMO MDC
PA43015OtherACS HEALTH NET COMMERCIAL
0876834OtherAETNA USHC BLUE BELL HMO
290999OtherBC BC OF NE PA ACCESS CAR
PA43015OtherACS HEALTH NET HMO MDC
P037811OtherTRI CARE NORTHEAST
PA43015OtherPHS HEALTH PLAN COMMERCIA
PA43015OtherQUALMED
PA43015OtherPHS HEALTH PLAN COMMERCIA
290999OtherBC BC OF NE PA ACCESS CAR