Healthcare Provider Details

I. General information

NPI: 1346395597
Provider Name (Legal Business Name): GALENA VOLUNTEER FIRE CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 EAST CROSS STREET
GALENA MD
21635
US

IV. Provider business mailing address

PO BOX 189
GALENA MD
21635-0189
US

V. Phone/Fax

Practice location:
  • Phone: 410-648-5050
  • Fax:
Mailing address:
  • Phone: 410-648-5050
  • Fax: 410-648-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0148360
License Number StateMD

VIII. Authorized Official

Name: MR. RICHARD T KOCH SR.
Title or Position: CHIEF
Credential: PARAMEDIC
Phone: 410-648-5050