MEDICARE: ROULETTE CHEMICAL ENGINE CO #1 INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	60602	PA
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1033388335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROULETTE CHEMICAL ENGINE CO #1 INC

Provider Business Mailing Address
First Line	:	PO BOX 172
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-0172
Country	:	US
Telephone Number	:	814-544-7762
Fax Number	:	814-544-7495

Provider Business Practice Location Address
First Line	:	12 RIVER ST
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-0172
Country	:	US
Telephone Number	:	814-544-7762
Fax Number	:	814-544-7495

Authorized Official
Title or Position	:	CHIEF
Name	:	JUSTIN WILLIAM FILLHART
Credential	:
Telephone Number	:	610-755-8153

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	07/06/2022

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