=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942364294
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRWIN VOLUNTEER FIRE DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2006
-----------------------------------------------------
Last Update Date | 03/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 WESTERN AVE
-----------------------------------------------------
City | IRWIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-864-3106
-----------------------------------------------------
Fax | 724-864-3107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 518 WESTERN AVE
-----------------------------------------------------
City | IRWIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15642
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-864-3106
-----------------------------------------------------
Fax | 724-864-3107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. CHAD A MOWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-864-3106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 06013
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------