Provider Demographics
NPI:1649240219
Name:FAYETTEVILLE VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:FAYETTEVILLE VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHREVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-352-7723
Mailing Address - Street 1:101 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-1428
Mailing Address - Country:US
Mailing Address - Phone:717-352-7723
Mailing Address - Fax:717-352-8302
Practice Address - Street 1:101 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17222-1428
Practice Address - Country:US
Practice Address - Phone:717-352-7723
Practice Address - Fax:717-352-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05003341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010609160002Medicaid
PA0010609160005Medicaid
PA0010609160002Medicaid