Provider Demographics
NPI:1821029455
Name:GOODWILL FIRE COMPANY INCORPORATED
Entity Type:Organization
Organization Name:GOODWILL FIRE COMPANY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:PALMATARY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-758-1422
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-0659
Mailing Address - Country:US
Mailing Address - Phone:410-758-1422
Mailing Address - Fax:410-758-3528
Practice Address - Street 1:212 BROADWAY
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-1008
Practice Address - Country:US
Practice Address - Phone:410-758-1422
Practice Address - Fax:410-758-3528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229088000Medicaid
MD229088000Medicaid
590008903Medicare PIN