Provider Demographics
NPI:1841242856
Name:WINDBER FIRE COMPANY NO 1
Entity Type:Organization
Organization Name:WINDBER FIRE COMPANY NO 1
Other - Org Name:NORTHERN EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:CICON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-467-9244
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15907-0816
Mailing Address - Country:US
Mailing Address - Phone:814-536-9951
Mailing Address - Fax:814-536-9952
Practice Address - Street 1:1620 SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1748
Practice Address - Country:US
Practice Address - Phone:814-467-9244
Practice Address - Fax:814-467-6796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00310341600000X
PA03325341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
080022400OtherBLACK LUNG PROGRAM
1832951OtherGATEWAY
590014073OtherPALMETTO GBA
PA0018329510002Medicaid
080022400OtherBLACK LUNG PROGRAM