Provider Demographics
NPI:1427033398
Name:LOYALSOCK VOLUNTEER FIRE COMPANY NUMBER ONE
Entity type:Organization
Organization Name:LOYALSOCK VOLUNTEER FIRE COMPANY NUMBER ONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MINNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-323-3603
Mailing Address - Street 1:700 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3100
Mailing Address - Country:US
Mailing Address - Phone:570-321-3032
Mailing Address - Fax:570-321-2263
Practice Address - Street 1:715 NORTHWAY RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3813
Practice Address - Country:US
Practice Address - Phone:570-323-3603
Practice Address - Fax:570-323-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA06012341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007038980002Medicaid
PA590145024OtherRAILROAD
PA281248Medicare PIN