Provider Demographics
NPI:1619030038
Name:WATER WITCH FIRE COMPANY INC
Entity Type:Organization
Organization Name:WATER WITCH FIRE COMPANY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOME
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:410-378-4223
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-0324
Mailing Address - Country:US
Mailing Address - Phone:410-378-4223
Mailing Address - Fax:
Practice Address - Street 1:15 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1209
Practice Address - Country:US
Practice Address - Phone:410-378-4223
Practice Address - Fax:410-378-9343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR139OtherFEDERAL BLUE SHIELD
MD72576OtherHEALTH AMERICA
MD389998500Medicaid
MDZ863OtherCAREFIRST BLUE CROSS
MDZ863OtherCAREFIRST BLUE CROSS
MDR139OtherFEDERAL BLUE SHIELD