Provider Demographics
NPI:1740348465
Name:FAIRCHANCE FIREMENS AMBULANCE
Entity type:Organization
Organization Name:FAIRCHANCE FIREMENS AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:EICHER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:724-564-9880
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:31 PITTSBURGH STREET
Mailing Address - City:FAIRCHANCE
Mailing Address - State:PA
Mailing Address - Zip Code:15436-0478
Mailing Address - Country:US
Mailing Address - Phone:724-564-9116
Mailing Address - Fax:724-564-1408
Practice Address - Street 1:31 PITTSBURGH STREET
Practice Address - Street 2:
Practice Address - City:FAIRCHANCE
Practice Address - State:PA
Practice Address - Zip Code:15436
Practice Address - Country:US
Practice Address - Phone:724-556-4911
Practice Address - Fax:724-564-1408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X
PA033753416L0300X
PA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered341600000XTransportation ServicesAmbulance
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018274230004Medicaid
TX=========OtherUNITED MINE WORKERS
PA0018274230004Medicaid