MEDICARE: FAIRMOUNT TOWNSHIP VOLUNTEER FIRE CO 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	208085	OTHER	PA	HIGHMARK BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	998548	OTHER	PA	BLUE CROSS OF NEPA

General Provider Information

NPI Number	:	1487757449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRMOUNT TOWNSHIP VOLUNTEER FIRE CO NO 1

Provider Business Mailing Address
First Line	:	671 STATE ROUTE 118
Second Line	:
City	:	SWEET VALLEY
State	:	PA
Zip	:	18656-2039
Country	:	US
Telephone Number	:	570-477-3691
Fax Number	:	570-477-2487

Provider Business Practice Location Address
First Line	:	671 STATE ROUTE 118
Second Line	:
City	:	SWEET VALLEY
State	:	PA
Zip	:	18656-2039
Country	:	US
Telephone Number	:	570-477-3691
Fax Number	:

Authorized Official
Title or Position	:	TREASURER/AMBULANCE CAPTAIN
Name	:	JILL MAUREEN SHAW
Credential	:
Telephone Number	:	570-477-3691

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	02/19/2016

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