Provider Demographics
NPI:1124167234
Name:BLOOMFIELD TOWNSHIP VFD
Entity type:Organization
Organization Name:BLOOMFIELD TOWNSHIP VFD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KALKBRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-654-7303
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-0061
Mailing Address - Country:US
Mailing Address - Phone:814-807-0670
Mailing Address - Fax:814-807-0673
Practice Address - Street 1:22978 SHREVE RIDGE RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-3550
Practice Address - Country:US
Practice Address - Phone:814-807-0670
Practice Address - Fax:814-807-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040123416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007603010004Medicaid
PA283883Medicare ID - Type Unspecified