Fellows Club Volunteer Fire Dept

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

FELLOWS CLUB VOLUNTEER FIRE DEPT

Doing business as

Fellows Club Ambulance Service

Practice address

1015 Strawberry Alley
Conneautville, PA 16406

Phone

(814) 587-2876

NPI assigned

Jul 19, 2006

Organization subpart

No

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

Authorized official

Name

Gerald F Carless

Title

Treasurer/Ambulance Chief

Phone

(814) 587-2876

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Fellows Club Ambulance Service Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466467200000",
    "number": "1962422550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 305",
            "city": "CONNEAUTVILLE",
            "state": "PA",
            "postal_code": "164060305",
            "telephone_number": "814-587-2876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 STRAWBERRY ALLEY",
            "city": "CONNEAUTVILLE",
            "state": "PA",
            "postal_code": "16406",
            "telephone_number": "814-587-2876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FELLOWS CLUB VOLUNTEER FIRE DEPT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2016-06-21",
        "status": "A",
        "authorized_official_last_name": "CARLESS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "TREASURER/AMBULANCE CHIEF",
        "authorized_official_telephone_number": "814-587-2876"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMERICA",
            "identifier": "336903",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "50149",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ION HEALTH",
            "identifier": "0015664520003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015664520003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fellows Club Ambulance Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Conneaut Valley Health Center Inc.
• Conneaut Valley Health Center Podiatry
• Conneaut Valley Health Center, Inc.
• Wesley C Davis, DPT
• Zachery Faust, DC
• Curtis Garrison, D.O.
• Karlie Gaydos, DPT
• Ryan Green, PTA
• Joseph John Kohler III, DDS
• John Paul Lukens, COTA/L

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.