Provider Demographics
NPI:1548244114
Name:JORDAN VOLUNTEER FIRE COMPANY INC
Entity Type:Organization
Organization Name:JORDAN VOLUNTEER FIRE COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:FIETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-689-3923
Mailing Address - Street 1:1 NORTH HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:NY
Mailing Address - Zip Code:13080
Mailing Address - Country:US
Mailing Address - Phone:315-689-3923
Mailing Address - Fax:
Practice Address - Street 1:1 NORTH HAMILTON ST
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:NY
Practice Address - Zip Code:13080
Practice Address - Country:US
Practice Address - Phone:315-689-3923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09841341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01201692Medicaid
P00042649OtherRAILROAD MEDICARE
956671OtherMVP
9697180OtherGHI
9697180OtherGHI