Healthcare Provider Details

I. General information

NPI: 1437158623
Provider Name (Legal Business Name): MARKLESBURG VOLUNTEER FIRE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RTE 26 NORTH
JAMES CREEK PA
16657
US

IV. Provider business mailing address

PO BOX 726
NEW CUMBERLAND PA
17070-0726
US

V. Phone/Fax

Practice location:
  • Phone: 814-658-2037
  • Fax:
Mailing address:
  • Phone: 717-214-6018
  • Fax: 717-214-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04121
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier000774808
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: PAUL SCHOCK
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 814-658-2037