Port Penn Vol Fire Co Inc

Primary specialty

AmbulanceTaxonomy code 341600000X

License

3573 Issued in DE

Legal business name

PORT PENN VOL FIRE CO INC

Practice address

26 W Market Street
Port Penn, DE 19731

Phone

(302) 834-7483

Fax

(302) 832-7622

NPI assigned

Sep 20, 2006

Last updated

Nov 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan Mark Stuckert

Title

Assistant Chief/EMS Supervisor

Phone

(302) 834-7483

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1194822551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W COMMONS BLVD",
            "address_2": "SUITE 210",
            "city": "NEW CASTLE",
            "state": "DE",
            "postal_code": "197202400",
            "telephone_number": "800-697-5147",
            "fax_number": "888-456-3155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 W MARKET STREET",
            "city": "PORT PENN",
            "state": "DE",
            "postal_code": "19731",
            "telephone_number": "302-834-7483",
            "fax_number": "302-832-7622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT PENN VOL FIRE CO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2024-11-29",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "STUCKERT",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "ASSISTANT CHIEF/EMS SUPERVISOR",
        "authorized_official_telephone_number": "302-834-7483"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "DE",
            "license": "3573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000669015",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.