Provider Demographics
NPI:1063639631
Name:DALTON FIRE COMPANY INCORPORATED
Entity type:Organization
Organization Name:DALTON FIRE COMPANY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-563-1313
Mailing Address - Street 1:PO BOX 684
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-0684
Mailing Address - Country:US
Mailing Address - Phone:570-563-1313
Mailing Address - Fax:570-563-2398
Practice Address - Street 1:109 S TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:PA
Practice Address - Zip Code:18414-9511
Practice Address - Country:US
Practice Address - Phone:570-563-1313
Practice Address - Fax:570-563-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012700920001Medicaid
PA01270092OtherUNISON
590011672Medicare PIN
PA289450Medicare PIN