Provider Demographics
NPI:1992785364
Name:OLD LYCOMING TOWNSHIP VOLUNTEER FIRE CO
Entity type:Organization
Organization Name:OLD LYCOMING TOWNSHIP VOLUNTEER FIRE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-323-7016
Mailing Address - Street 1:700 HIGH STREET
Mailing Address - Street 2:C/O WILLIAMSPORT AREA AMBULANCE SERVICE
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3109
Mailing Address - Country:US
Mailing Address - Phone:570-321-2003
Mailing Address - Fax:570-321-2263
Practice Address - Street 1:1600 DEWEY AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1514
Practice Address - Country:US
Practice Address - Phone:570-323-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA052433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA052811OtherFIRST PRIORITY HEALTH
PA590645093OtherRAILROAD MEDICARE
PA0008038840002Medicaid
=========OtherCOMMERICAL PAYORS
PA0008038840002Medicaid
=========OtherCOMMERICAL PAYORS