Provider Demographics
NPI:1194822551
Name:PORT PENN VOL FIRE CO INC
Entity type:Organization
Organization Name:PORT PENN VOL FIRE CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF/EMS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:STUCKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-834-7483
Mailing Address - Street 1:100 W COMMONS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-2400
Mailing Address - Country:US
Mailing Address - Phone:800-697-5147
Mailing Address - Fax:888-456-3155
Practice Address - Street 1:26 W MARKET STREET
Practice Address - Street 2:
Practice Address - City:PORT PENN
Practice Address - State:DE
Practice Address - Zip Code:19731
Practice Address - Country:US
Practice Address - Phone:302-834-7483
Practice Address - Fax:302-832-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE3573341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000669015Medicaid
DE0000669015Medicaid