Provider Demographics
NPI:1215917828
Name:FIRE DEPARTMENT OF NORTH VERSAILLES
Entity type:Organization
Organization Name:FIRE DEPARTMENT OF NORTH VERSAILLES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-829-7378
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NORTH VERSAILLES
Mailing Address - State:PA
Mailing Address - Zip Code:15137-0220
Mailing Address - Country:US
Mailing Address - Phone:412-829-7378
Mailing Address - Fax:412-200-5615
Practice Address - Street 1:1021 BROAD ST
Practice Address - Street 2:
Practice Address - City:NORTH VERSAILLES
Practice Address - State:PA
Practice Address - Zip Code:15137-2101
Practice Address - Country:US
Practice Address - Phone:412-829-7378
Practice Address - Fax:412-200-5615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030773416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010400920003Medicaid
PA590014680OtherRRMEDICARE/PALMETTO GBA
PA218247OtherUMPC HEALTH
PA239725OtherBLUE CROSS/BLUE SHIELD
PA050243Medicare UPIN