Healthcare Provider Details

I. General information

NPI: 1922083070
Provider Name (Legal Business Name): TROUT RUN VOLUNTEER FIRE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 STEAM VALLEY RD C/O DEBORAH A. PASSUELLO
TROUT RUN PA
17771-9100
US

IV. Provider business mailing address

700 HIGH STREET C/O WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
WILLIAMSPORT PA
17701-3109
US

V. Phone/Fax

Practice location:
  • Phone: 570-998-8211
  • Fax:
Mailing address:
  • Phone: 570-321-2003
  • Fax: 570-321-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number4101416
License Number StatePA

VIII. Authorized Official

Name: MS. DEBORAH A PASSUELLO
Title or Position: TREASURER
Credential:
Phone: 570-998-8211