Provider Demographics
NPI:1750427027
Name:JUSTUS VOLUNTEER FIRE COMPANY
Entity type:Organization
Organization Name:JUSTUS VOLUNTEER FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECORDING SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-BASIC
Authorized Official - Phone:570-840-0703
Mailing Address - Street 1:159 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTT TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8812
Mailing Address - Country:US
Mailing Address - Phone:570-587-4545
Mailing Address - Fax:
Practice Address - Street 1:159 FIELDSTONE DR
Practice Address - Street 2:
Practice Address - City:SCOTT TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8812
Practice Address - Country:US
Practice Address - Phone:570-587-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590002433OtherRR MEDICARE
PA00169499000001Medicaid
PA590002433OtherRR MEDICARE
PA200929Medicare ID - Type Unspecified