South Mountain Volunteer Fire Company

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

SOUTH MOUNTAIN VOLUNTEER FIRE COMPANY

Practice address

11207 Loop Rd
Fayetteville, PA 17222-9284

Phone

(717) 749-5733

Fax

(717) 749-5219

NPI assigned

Aug 18, 2005

Last updated

Jan 21, 2013By 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

Stacy J Staley

Title

EMS Supervior

Phone

(717) 749-5733

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358726400000",
    "number": "1205828944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92",
            "city": "SOUTH MOUNTAIN",
            "state": "PA",
            "postal_code": "172610092",
            "telephone_number": "717-749-5733",
            "fax_number": "717-749-5219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11207 LOOP RD",
            "city": "FAYETTEVILLE",
            "state": "PA",
            "postal_code": "172229284",
            "telephone_number": "717-749-5733",
            "fax_number": "717-749-5219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH MOUNTAIN VOLUNTEER FIRE COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2013-01-21",
        "status": "A",
        "authorized_official_last_name": "STALEY",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EMS SUPERVIOR",
        "authorized_official_telephone_number": "717-749-5733"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018234600001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "411464700",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002579",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Adam Patrick Rowland, M.S. CCC-SLP
• Meredith Jean Schellhase, PA-C
• Monica Scoville Tudorache, MA
• Alivia Margarett Shank
• Enoch Graham Shissler, MD
• Suretrust Home Care LLC
• Brandy Alaine Swoyer
• Breia Szagola, MSOTR/L
• Brittani Lee Timmons, COTA/L
• Waynesboro Hospital (WellSpan Waynesboro Hospital)

• Land Ambulance in Fayetteville, PA
• Providers in Fayetteville, PA by specialty
• Land Ambulance in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; 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.