MEDICARE: DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT

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	04171	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	800577	OTHER	FIRST PRIORITY HEALTH
3	P037811	OTHER	TRI CARE MID ATL
4	290999	OTHER	BC BS OF PA BLUE SHIELD
5	833908	OTHER	UMWA HEALTH & RETIREMENT
6	PA43015	OTHER	PHS HEALTH PLAN HMO MDC
7	PA43015	OTHER	ACS HEALTH NET COMMERCIAL
8	0876834	OTHER	AETNA USHC BLUE BELL HMO
9	290999	OTHER	BC BC OF NE PA ACCESS CAR
10	PA43015	OTHER	ACS HEALTH NET HMO MDC
11	P037811	OTHER	TRI CARE NORTHEAST
12	PA43015	OTHER	PHS HEALTH PLAN COMMERCIA
13	PA43015	OTHER	QUALMED

General Provider Information

NPI Number	:	1508852575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORRANCE TOWNSHIP VOLUNTEER FIRE DEPT

Provider Business Mailing Address
First Line	:	PO BOX 207
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-0207
Country	:	US
Telephone Number	:	484-664-2007
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 SAINT JOHNS RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-1627
Country	:	US
Telephone Number	:	570-868-5357
Fax Number	:	570-868-3488

Authorized Official
Title or Position	:	AMBULANCE CHIEF
Name	:	JEFF KOTARSKY
Credential	:	EMT
Telephone Number	:	570-868-5357

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	11/09/2011

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