MEDICARE: KEYSTONE HOOK & LADDER COMPANY NO 1

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447461181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE HOOK & LADDER COMPANY NO 1

Provider Business Mailing Address
First Line	:	35 S. MAIN ST.
Second Line	:
City	:	MUNCY
State	:	PA
Zip	:	17756-1306
Country	:	US
Telephone Number	:	570-546-3000
Fax Number	:	570-546-3300

Provider Business Practice Location Address
First Line	:	35 S. MAIN ST.
Second Line	:
City	:	MUNCY
State	:	PA
Zip	:	17756-1306
Country	:	US
Telephone Number	:	570-546-3000
Fax Number	:	570-546-3300

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. DANA E BERTIN
Credential	:
Telephone Number	:	570-546-3000

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	05/10/2011

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