Provider Demographics
NPI:1720124795
Name:CLARKS SUMMIT FIRE COMPANY NO 1 INC
Entity Type:Organization
Organization Name:CLARKS SUMMIT FIRE COMPANY NO 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-586-9656
Mailing Address - Street 1:PO BOX M
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-0983
Mailing Address - Country:US
Mailing Address - Phone:570-586-9656
Mailing Address - Fax:570-587-6003
Practice Address - Street 1:321 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1800
Practice Address - Country:US
Practice Address - Phone:570-586-9656
Practice Address - Fax:570-587-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590009213OtherUNITED HEALTH CARE
PA079474OtherFIRST PRIORITY HEALTH
PA0012007210001Medicaid
PA281646Medicare PIN