Healthcare Provider Details

I. General information

NPI: 1437470705
Provider Name (Legal Business Name): VANDERGRIFT FIRE DEPARTMENT NO 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 HOLLAND STREET
VANDERGRIFT PA
15690-1444
US

IV. Provider business mailing address

700 HOLLAND STREET
VANDERGRIFT PA
15690-1444
US

V. Phone/Fax

Practice location:
  • Phone: 724-568-3864
  • Fax: 724-794-1633
Mailing address:
  • Phone: 724-568-3864
  • Fax: 724-794-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number06079
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1025423220003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: JAMES M CAPORALI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 724-568-3864