Healthcare Provider Details

I. General information

NPI: 1316097967
Provider Name (Legal Business Name): CONFLUENCE VOLUNTEER FIRE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 BAXTER ST
CONFLUENCE PA
15424-1045
US

IV. Provider business mailing address

117 BAXTER ST PO BOX 73
CONFLUENCE PA
15424-1045
US

V. Phone/Fax

Practice location:
  • Phone: 814-395-5242
  • Fax: 814-395-5242
Mailing address:
  • Phone: 814-395-5242
  • Fax: 814-395-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05154
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0007826770001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. ALLAN TODD SUDER
Title or Position: PRESIDENT
Credential: EMT
Phone: 814-395-5242