Provider Demographics
NPI:1568468064
Name:EUREKA VOLUNTEER FIRE AND AMBULANCE COMPANY INC.
Entity Type:Organization
Organization Name:EUREKA VOLUNTEER FIRE AND AMBULANCE COMPANY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WISNOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-993-6180
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-0726
Mailing Address - Country:US
Mailing Address - Phone:717-214-6018
Mailing Address - Fax:717-214-6020
Practice Address - Street 1:82 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STEWARTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17363-4033
Practice Address - Country:US
Practice Address - Phone:717-993-6180
Practice Address - Fax:717-993-0348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042193416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001219993Medicaid
PA215906Medicare ID - Type Unspecified