Provider Demographics
NPI:1750412151
Name:RENNERDALE VOLUNTEER FIRE DEPARTMENT
Entity type:Organization
Organization Name:RENNERDALE VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUFFENNACH
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:412-400-8012
Mailing Address - Street 1:30 SUBURBAN AVE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-1489
Mailing Address - Country:US
Mailing Address - Phone:412-276-9652
Mailing Address - Fax:
Practice Address - Street 1:30 SUBURBAN AVE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-1489
Practice Address - Country:US
Practice Address - Phone:412-276-9652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012483416L0300X
PA042513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011914800001Medicaid
PA203819OtherHIGHMARK BLUE SHIELD
PA334314Medicare UPIN
PA20656Medicare UPIN
PA590004875Medicare ID - Type UnspecifiedRAILROAD RETIREES
PA0515789Medicare UPIN
PA203819OtherHIGHMARK BLUE SHIELD