=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609900588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKE WINOLA FIRE COMPANY NO 1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1204 SR 307
-----------------------------------------------------
City | FACTORYVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18419-7880
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-378-2000
-----------------------------------------------------
Fax | 570-378-3763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 73
-----------------------------------------------------
City | LAKE WINOLA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18625-0073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-378-2000
-----------------------------------------------------
Fax | 570-378-3763
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | DANIEL WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-378-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------