Provider Demographics
NPI:1912049933
Name:WILCOX VOLUNTEER FIRE DEPARTMENT
Entity Type:Organization
Organization Name:WILCOX VOLUNTEER FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:THOR
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:814-929-5843
Mailing Address - Street 1:84 LAWRENCE STREET PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:WILCOX
Mailing Address - State:PA
Mailing Address - Zip Code:15870-0117
Mailing Address - Country:US
Mailing Address - Phone:814-929-5330
Mailing Address - Fax:814-929-5330
Practice Address - Street 1:84 LAWRENCE STREET
Practice Address - Street 2:
Practice Address - City:WILCOX
Practice Address - State:PA
Practice Address - Zip Code:15870-0117
Practice Address - Country:US
Practice Address - Phone:814-929-5330
Practice Address - Fax:814-929-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA24005341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0078251770001Medicaid
PA065967Medicare ID - Type Unspecified