Healthcare Provider Details

I. General information

NPI: 1598058513
Provider Name (Legal Business Name): GORDONVILLE FIRE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 VIGILANT ST.
GORDONVILLE PA
17529
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 717-769-3869
  • Fax:
Mailing address:
  • Phone: 484-664-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number06102
License Number StatePA

VIII. Authorized Official

Name: DAVID WEAVER
Title or Position: PRESIDENT
Credential:
Phone: 717-768-3869