Old Lycoming Township Volunteer Fire Co
Organization Active NPI Land Ambulance · Williamsport, PA
NPI 1992785364 · NPPES record last updated Jul 11, 2012
Key facts
- NPI
- 1992785364
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Land Ambulance 3416L0300X
- License
- 05243 (PA)
- Legal business name
- OLD LYCOMING TOWNSHIP VOLUNTEER FIRE CO
- Practice address
- 1600 Dewey Ave
Williamsport, PA 17701-1514 - Phone
- (570) 323-7016
- NPI assigned
- Jan 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Scott Hope
- Title
- President
- Phone
- (570) 323-7016
Member organizations 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 39D2260394 | The Old Lycoming Township Volunteer Fire Company | Certificate of waiver | May 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060502000221 | PA | Part B Supplier - Ambulance Service Supplier | 6709896004 | Practice locations: Williamsport, PA |
National Provider Directory
Locations
1600 Dewey Ave
Williamsport, PA 17701
Phone (570) 323-1665
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 05243 | PA | Yes |
Addresses
Primary practice location
1600 Dewey Ave
Williamsport, PA 17701-1514
Mailing address
700 High Street
C/O Williamsport Area Ambulance Service
Williamsport, PA 17701-3109
Phone (570) 321-2003
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 052811 | Other | PA | FIRST PRIORITY HEALTH |
| 590645093 | Other | PA | RAILROAD MEDICARE |
| 0008038840002 | Medicaid | PA |
Other providers in Williamsport, PA
- Tia Gialuong O'Brien
- Wanda Louise O'Neill
- Amber Obrien
- Mark Odorizzi
- Diana Ohl
- Sharad Oli
- Stuart Olinsky
- Kurt H Olsen
- Douglas J Ombongi
- Myoe Htet Htet Oo
All providers in Williamsport, PA · Land Ambulance in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.