Provider Demographics
NPI:1295942191
Name:KENNETT FIRE COMPANY NUMBER 1
Entity type:Organization
Organization Name:KENNETT FIRE COMPANY NUMBER 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:EICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-972-6175
Mailing Address - Street 1:301 DALMATIAN STREET
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3804
Mailing Address - Country:US
Mailing Address - Phone:610-444-4810
Mailing Address - Fax:
Practice Address - Street 1:301 DALMATIAN ST
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-3804
Practice Address - Country:US
Practice Address - Phone:610-444-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007005460001Medicaid
PA0007005460001Medicaid