Provider Demographics
NPI:1821010331
Name:SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1
Entity Type:Organization
Organization Name:SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN/BILLING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WIATEROWSKI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-868-6255
Mailing Address - Street 1:1923 SLOCUM RD
Mailing Address - Street 2:
Mailing Address - City:WAPWALLOPEN
Mailing Address - State:PA
Mailing Address - Zip Code:18660-8886
Mailing Address - Country:US
Mailing Address - Phone:570-868-6255
Mailing Address - Fax:570-868-3815
Practice Address - Street 1:1923 SLOCUM RD
Practice Address - Street 2:
Practice Address - City:WAPWALLOPEN
Practice Address - State:PA
Practice Address - Zip Code:18660-8886
Practice Address - Country:US
Practice Address - Phone:570-868-6255
Practice Address - Fax:570-868-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083364100OtherFEDERAL BLACK LUNG PROG
PA248702OtherHIGHMARK BS
PA998571OtherBLUE CROSS NEPA
PA1011294690001Medicaid
PA1011294690001Medicaid
PA248702OtherHIGHMARK BS