Provider Demographics
NPI:1619963782
Name:OTTO TOWNSHIP VOLUNTEER FIRE DEPARTMENT & AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:OTTO TOWNSHIP VOLUNTEER FIRE DEPARTMENT & AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:RETTGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-598-5822
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:800-473-2278
Mailing Address - Fax:
Practice Address - Street 1:118 SWEITZER DR
Practice Address - Street 2:
Practice Address - City:DUKE CENTER
Practice Address - State:PA
Practice Address - Zip Code:16729-9506
Practice Address - Country:US
Practice Address - Phone:814-966-3311
Practice Address - Fax:814-966-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA043063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011940250005Medicaid
PA213777OtherBCBS
PA213777OtherBCBS
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