Provider Demographics
NPI:1922083070
Name:TROUT RUN VOLUNTEER FIRE COMPANY
Entity Type:Organization
Organization Name:TROUT RUN VOLUNTEER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PASSUELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-998-8211
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 1:452 STEAM VALLEY RD
Practice Address - Street 2:C/O DEBORAH A. PASSUELLO
Practice Address - City:TROUT RUN
Practice Address - State:PA
Practice Address - Zip Code:17771-9100
Practice Address - Country:US
Practice Address - Phone:570-998-8211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA41014163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007750460002Medicaid
=========OtherCOMMERICAL PAYORS
PA0007750460002Medicaid
201309Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER