Healthcare Provider Details

I. General information

NPI: 1093094872
Provider Name (Legal Business Name): MCCOOLE FIRE AND RESCUE DEPT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24931 CROOKS AVE SW
MCCOOLE MD
21562-3013
US

IV. Provider business mailing address

PO BOX 504
DENTON MD
21629-0504
US

V. Phone/Fax

Practice location:
  • Phone: 301-786-4311
  • Fax: 301-786-7890
Mailing address:
  • Phone: 410-479-4790
  • Fax: 410-479-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: CATHY LYNN CARTER
Title or Position: BILLING PROFESSIONAL
Credential:
Phone: 410-479-4790