MEDICARE: FAYETTEVILLE VOLUNTEER FIRE DEPARTMENT

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	341600000X	Ambulance	05003	PA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649240219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAYETTEVILLE VOLUNTEER FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	101 W MAIN ST
Second Line	:
City	:	FAYETTEVILLE
State	:	PA
Zip	:	17222-1428
Country	:	US
Telephone Number	:	717-352-7723
Fax Number	:	717-352-8302

Provider Business Practice Location Address
First Line	:	101 W MAIN ST
Second Line	:
City	:	FAYETTEVILLE
State	:	PA
Zip	:	17222-1428
Country	:	US
Telephone Number	:	717-352-7723
Fax Number	:	717-352-8302

Authorized Official
Title or Position	:	BILLING OFFICE MANAGER
Name	:	MRS. LESLIE K SHREVE
Credential	:
Telephone Number	:	717-352-7723

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	05/05/2014

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Directions to “FAYETTEVILLE VOLUNTEER FIRE DEPARTMENT ” Practice Location

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