Provider Demographics
NPI:1861479198
Name:SOUTH WILLIAMSPORT FIRE DEPARTMENT
Entity Type:Organization
Organization Name:SOUTH WILLIAMSPORT FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-326-4167
Mailing Address - Street 1:700 HIGH STREET
Mailing Address - Street 2:C/O WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3109
Mailing Address - Country:US
Mailing Address - Phone:570-321-2003
Mailing Address - Fax:570-321-2263
Practice Address - Street 1:573 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-7604
Practice Address - Country:US
Practice Address - Phone:570-326-4167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA410033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA803606OtherFIRST PRIORITY HEALTH
PA998540OtherBLUE CROSS/BLUE SHIELD
PA0008815300002Medicaid
PA803606OtherFIRST PRIORITY HEALTH
PA0008815300002Medicaid
PA0008815300002Medicaid