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General NPI Number Information
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NPI Number | 1992785364
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Entity Type | Organization
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Legal Business Name | OLD LYCOMING TOWNSHIP VOLUNTEER FIRE CO
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 1600 DEWEY AVE
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-1514
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Country | US
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Telephone | 570-323-7016
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Fax |
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Provider Business Mailing Address
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Address Line | 700 HIGH STREET C/O WILLIAMSPORT AREA AMBULANCE SERVICE
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-3109
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Country | US
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Telephone | 570-321-2003
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Fax | 570-321-2263
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SCOTT HOPE
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Credential |
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Telephone | 570-323-7016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 05243
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License Number State | PA
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