Healthcare Provider Details

I. General information

NPI: 1962422550
Provider Name (Legal Business Name): FELLOWS CLUB VOLUNTEER FIRE DEPT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 STRAWBERRY ALLEY
CONNEAUTVILLE PA
16406
US

IV. Provider business mailing address

PO BOX 305
CONNEAUTVILLE PA
16406-0305
US

V. Phone/Fax

Practice location:
  • Phone: 814-587-2876
  • Fax:
Mailing address:
  • Phone: 814-587-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: GERALD F CARLESS
Title or Position: TREASURER/AMBULANCE CHIEF
Credential:
Phone: 814-587-2876