Healthcare Provider Details

I. General information

NPI: 1750427027
Provider Name (Legal Business Name): JUSTUS VOLUNTEER FIRE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 FIELDSTONE DR
SCOTT TOWNSHIP PA
18411-8812
US

IV. Provider business mailing address

159 FIELDSTONE DR
SCOTT TOWNSHIP PA
18411-8812
US

V. Phone/Fax

Practice location:
  • Phone: 570-587-4545
  • Fax:
Mailing address:
  • Phone: 570-587-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05039
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier590002433
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE
# 2
Identifier00169499000001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. HEATH G GOLDSTEIN
Title or Position: RECORDING SECRETARY
Credential: EMT-BASIC
Phone: 570-840-0703