MEDICARE: CERRO GORDO VOLUNTEER FIRE DEPARTMENT AND RESCUE SQUAD 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		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417904277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERRO GORDO VOLUNTEER FIRE DEPARTMENT AND RESCUE SQUAD INC

Provider Business Mailing Address
First Line	:	409 PORTER AVE
Second Line	:
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-1141
Country	:	US
Telephone Number	:	247-887-6822
Fax Number	:	724-887-9440

Provider Business Practice Location Address
First Line	:	75 E RAILROAD ST
Second Line	:
City	:	CERRO GORDO
State	:	NC
Zip	:	28430-9700
Country	:	US
Telephone Number	:	910-654-3535
Fax Number	:	910-654-4825

Authorized Official
Title or Position	:	EMS COORDINATOR
Name	:	MALIK WASHINGTON
Credential	:
Telephone Number	:	910-207-1305

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/02/2024

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