Riverside Vol. Fire Dept.

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

1103433 Issued in PA

Legal business name

RIVERSIDE VOL. FIRE DEPT.

Practice address

615 Liberty Ave
Johnstown, PA 15905-3609

Phone

(814) 288-1100

Fax

(814) 487-7137

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Jay Daniels

Title

Fire Chief

Phone

(814) 288-1076

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689751174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 LIBERTY AVE",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159053609",
            "telephone_number": "814-288-1100",
            "fax_number": "814-487-7137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 LIBERTY AVE",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159053609",
            "telephone_number": "814-288-1100",
            "fax_number": "814-487-7137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE VOL. FIRE DEPT.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "FIRE CHIEF",
        "authorized_official_telephone_number": "814-288-1076",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "1103433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012277520004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary F Risko, PAC
• Rite Aid of Pennsylvania LLC
• Rite Aid of Pennsylvania LLC
• Rite Aid of Pennsylvania LLC
• Riverbank Wellness, LLC
• Waheeb M. Rizkalla, MD
• Jacob Wesley Roberts, PA-C
• Justin Patrick Roberts
• Kimberly A. Roberts, MSW
• Morgan Roberts, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.