Provider Demographics
NPI:1932169422
Name:FAIRVIEW TOWNSHIP EMERGENCY MEDICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:FAIRVIEW TOWNSHIP EMERGENCY MEDICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAUGANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-932-6101
Mailing Address - Street 1:522 LOCUST RD
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-3139
Mailing Address - Country:US
Mailing Address - Phone:717-932-6101
Mailing Address - Fax:717-932-4424
Practice Address - Street 1:522 LOCUST RD
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-3139
Practice Address - Country:US
Practice Address - Phone:717-932-6101
Practice Address - Fax:717-932-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03221146L00000X
146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015505320002Medicaid
PA281553Medicare ID - Type Unspecified