Healthcare Provider Details

I. General information

NPI: 1649240219
Provider Name (Legal Business Name): FAYETTEVILLE VOLUNTEER FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MAIN ST
FAYETTEVILLE PA
17222-1428
US

IV. Provider business mailing address

101 W MAIN ST
FAYETTEVILLE PA
17222-1428
US

V. Phone/Fax

Practice location:
  • Phone: 717-352-7723
  • Fax: 717-352-8302
Mailing address:
  • Phone: 717-352-7723
  • Fax: 717-352-8302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number05003
License Number StatePA

VIII. Authorized Official

Name: MRS. LESLIE K SHREVE
Title or Position: BILLING OFFICE MANAGER
Credential:
Phone: 717-352-7723