Provider Demographics
NPI:1679550917
Name:LAIRDSVILLE COMMUNITY VOL FIRE CO
Entity type:Organization
Organization Name:LAIRDSVILLE COMMUNITY VOL FIRE CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-452-8191
Mailing Address - Street 1:PO BOX 290184
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06129-0184
Mailing Address - Country:US
Mailing Address - Phone:800-452-8191
Mailing Address - Fax:860-721-6362
Practice Address - Street 1:143 SCHOOL LANE
Practice Address - Street 2:
Practice Address - City:LAIRDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17742-0034
Practice Address - Country:US
Practice Address - Phone:570-584-2605
Practice Address - Fax:570-329-4947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04128341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000784448 0001Medicaid
PA076885Medicare PIN