Provider Demographics
NPI:1639146590
Name:THE BOOTHWYN FIRE COMPANY NO 1
Entity Type:Organization
Organization Name:THE BOOTHWYN FIRE COMPANY NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-574-7608
Mailing Address - Street 1:1405 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3633
Mailing Address - Country:US
Mailing Address - Phone:610-485-0269
Mailing Address - Fax:610-485-9548
Practice Address - Street 1:1405 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-3633
Practice Address - Country:US
Practice Address - Phone:610-485-0269
Practice Address - Fax:610-485-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05216341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001426080002Medicaid
PA200831Medicare ID - Type Unspecified