=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104924893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ODESSA FIRE COMPANY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 10/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 MAIN ST
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-378-8929
-----------------------------------------------------
Fax | 302-378-6072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 41263
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10304-7263
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-456-4629
-----------------------------------------------------
Fax | 302-224-2848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | RICHARD TINCIA SR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 302-378-8929
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | 3542
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------