Provider Demographics
NPI:1720066855
Name:GENESEE TOWNSHIP VOLUNTEER FIRE
Entity Type:Organization
Organization Name:GENESEE TOWNSHIP VOLUNTEER FIRE
Other - Org Name:GENESEE TOWNSHIP VOLUNTEER FIRE DEPARTMENT INC
Other - Org Type:Other Name
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-203-1498
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:GENESEE
Practice Address - State:PA
Practice Address - Zip Code:16923-8806
Practice Address - Country:US
Practice Address - Phone:814-228-3319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015032830005Medicaid
PA1612753OtherBLUE CROSS/BLUE SHIELD
PA0015032830004Medicaid
PA0015032830004Medicaid