Provider Demographics
NPI:1689653933
Name:FAIRFIELD HOSE COMPANY
Entity Type:Organization
Organization Name:FAIRFIELD HOSE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWRYLIW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-881-6193
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:4896 E LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1415
Practice Address - Country:US
Practice Address - Phone:814-898-0007
Practice Address - Fax:814-899-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-14
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA011733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011361100003Medicaid
PA441590165OtherRR MEDICARE/PALMETTO GBA
PA282494OtherBLUE CROSS/BLUE SHIELD
PA0011361100003Medicaid
PA282494Medicare ID - Type Unspecified