Provider Demographics
NPI:1710964374
Name:WHITE DEER TOWNSHIP VOLUNTEER FIREMANS RELIEF ASSOCIATION
Entity Type:Organization
Organization Name:WHITE DEER TOWNSHIP VOLUNTEER FIREMANS RELIEF ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:WERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-568-3334
Mailing Address - Street 1:366 CEMETARY ST
Mailing Address - Street 2:
Mailing Address - City:NEW COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17856-9176
Mailing Address - Country:US
Mailing Address - Phone:570-568-3334
Mailing Address - Fax:570-568-1923
Practice Address - Street 1:366 CEMETARY ST
Practice Address - Street 2:
Practice Address - City:NEW COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17856-9176
Practice Address - Country:US
Practice Address - Phone:570-568-3334
Practice Address - Fax:570-568-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012658510003Medicaid
590002284Medicare PIN
PA285121Medicare PIN