MEDICARE: SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	083364100	OTHER	PA	FEDERAL BLACK LUNG PROG
2	248702	OTHER	PA	HIGHMARK BS
3	998571	OTHER	PA	BLUE CROSS NEPA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821010331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1

Provider Business Mailing Address
First Line	:	1923 SLOCUM RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-8886
Country	:	US
Telephone Number	:	570-868-6255
Fax Number	:	570-868-3815

Provider Business Practice Location Address
First Line	:	1923 SLOCUM RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-8886
Country	:	US
Telephone Number	:	570-868-6255
Fax Number	:	570-868-3815

Authorized Official
Title or Position	:	EMS CAPTAIN/BILLING OFFICER
Name	:	THEODORE M WIATEROWSKI JR.
Credential	:
Telephone Number	:	570-868-6255

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/11/2013

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Directions to “SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1 ” Practice Location

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