Provider Demographics
NPI:1609050426
Name:SUGARLOAF FIRE COMPANY, INC.
Entity Type:Organization
Organization Name:SUGARLOAF FIRE COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-788-2249
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:SYBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18251-0080
Mailing Address - Country:US
Mailing Address - Phone:570-788-2249
Mailing Address - Fax:
Practice Address - Street 1:95 WEST COUNTY ROAD
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249
Practice Address - Country:US
Practice Address - Phone:570-788-2249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020901620001Medicaid
PA120792Medicare PIN