Provider Demographics
NPI:1669473906
Name:WOODLYN FIRE COMPANY
Entity Type:Organization
Organization Name:WOODLYN FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLTROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-833-5338
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-0217
Mailing Address - Country:US
Mailing Address - Phone:610-833-5338
Mailing Address - Fax:610-833-2873
Practice Address - Street 1:228 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1303
Practice Address - Country:US
Practice Address - Phone:610-833-5338
Practice Address - Fax:610-833-2873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03311341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012211780006Medicaid
PA91267OtherAETNA
PA0001462000OtherINDEPENDENCE BLUE CROSS
PA91267OtherAETNA