=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033282645
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LEVEL VOLUNTEER FIRE COMPANY INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3633 LEVEL VILLAGE RD
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-734-6880
-----------------------------------------------------
Fax | 410-734-7207
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3633 LEVEL VILLAGE RD
-----------------------------------------------------
City | HAVRE DE GRACE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21078-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-734-6880
-----------------------------------------------------
Fax | 410-734-7207
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHARLES D BURKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-734-6880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------