Provider Demographics
NPI:1851374508
Name:LAKE MISHNOCK VOLUNTEER FIRE
Entity Type:Organization
Organization Name:LAKE MISHNOCK VOLUNTEER FIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:GALLIGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:401-397-7353
Mailing Address - Street 1:PO BOX 20104
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-0927
Mailing Address - Country:US
Mailing Address - Phone:401-572-3120
Mailing Address - Fax:401-572-3351
Practice Address - Street 1:166 MISHNOCK RD
Practice Address - Street 2:
Practice Address - City:W GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1669
Practice Address - Country:US
Practice Address - Phone:401-397-7353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI50341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
BQ409256OtherBLUE CHIP
RI0000007822OtherBLUE CROSS BLUE SHIELD
MA1709119Medicaid
RI9007822Medicaid
703427OtherHARVARD PILGRIM
RI9007822Medicaid
703427OtherHARVARD PILGRIM
RI0000007822OtherBLUE CROSS BLUE SHIELD