Provider Demographics
NPI:1154346930
Name:LAPORTE BOROUGH VOLUNTEER FIRE COMP
Entity type:Organization
Organization Name:LAPORTE BOROUGH VOLUNTEER FIRE COMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:I
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-946-4136
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:PA
Mailing Address - Zip Code:18626-0031
Mailing Address - Country:US
Mailing Address - Phone:570-946-4136
Mailing Address - Fax:570-946-4324
Practice Address - Street 1:114 MAPLE ST
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:PA
Practice Address - Zip Code:18626-0114
Practice Address - Country:US
Practice Address - Phone:570-946-4136
Practice Address - Fax:570-946-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017438330004Medicaid
PA200163Medicare PIN
PA0017438330004Medicaid