Provider Demographics
NPI:1699866806
Name:KUNKLE FIRE COMPANY, INC
Entity type:Organization
Organization Name:KUNKLE FIRE COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-675-3334
Mailing Address - Street 1:RR 1 BOX 301A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-9734
Mailing Address - Country:US
Mailing Address - Phone:570-675-3334
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 301A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-9734
Practice Address - Country:US
Practice Address - Phone:570-675-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015204170003Medicaid
PA080039500OtherFEDERAL BLACK LUNG
590011183Medicare PIN
PA219855Medicare PIN