MEDICARE: CENTRAL CITY 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	146N00000X	Basic Emergency Medical Technician	5630907	PA

General Provider Information

NPI Number	:	1992846125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CITY FIRE DEPARTMENT

Provider Business Mailing Address
First Line	:	241 SUNSHINE AVE
Second Line	:
City	:	CENTRAL CITY
State	:	PA
Zip	:	15926-1164
Country	:	US
Telephone Number	:	814-754-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 SUNSHINE AVE
Second Line	:
City	:	CENTRAL CITY
State	:	PA
Zip	:	15926-1164
Country	:	US
Telephone Number	:	814-754-5111
Fax Number	:

Authorized Official
Title or Position	:	FIRE CHIEF
Name	:	MR. WILLIAM DALE RUSSIAN
Credential	:	B.S.
Telephone Number	:	814-754-5111

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	08/22/2020

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