Provider Demographics
NPI:1972728996
Name:WEST WYOMING VOLUNTEER HOSE COMPANY #1
Entity type:Organization
Organization Name:WEST WYOMING VOLUNTEER HOSE COMPANY #1
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-693-3983
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-0846
Mailing Address - Country:US
Mailing Address - Phone:570-675-6125
Mailing Address - Fax:570-608-4015
Practice Address - Street 1:926 SHOEMAKER AVE
Practice Address - Street 2:
Practice Address - City:WEST WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1122
Practice Address - Country:US
Practice Address - Phone:570-693-2779
Practice Address - Fax:570-693-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040363416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590015131OtherRAILROAD MEDICARE
PA0014351830001Medicaid
PA590015131OtherRAILROAD MEDICARE
PA0014351830001Medicaid