Healthcare Provider Details

I. General information

NPI: 1194822551
Provider Name (Legal Business Name): PORT PENN VOL FIRE CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/29/2024
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 W MARKET STREET
PORT PENN DE
19731
US

IV. Provider business mailing address

100 W COMMONS BLVD SUITE 210
NEW CASTLE DE
19720-2400
US

V. Phone/Fax

Practice location:
  • Phone: 302-834-7483
  • Fax: 302-832-7622
Mailing address:
  • Phone: 800-697-5147
  • Fax: 888-456-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number3573
License Number StateDE

VIII. Authorized Official

Name: RYAN MARK STUCKERT
Title or Position: ASSISTANT CHIEF/EMS SUPERVISOR
Credential:
Phone: 302-834-7483