Basic Information
Provider Information
NPI: 1093855785
EntityType: 2
ReplacementNPI:  
OrganizationName: MILLVILLE VOLUNTEER FIRE COMPANY INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 71 OMEGA DR
Address2: BUILDING D
City: NEWARK
State: DE
PostalCode: 197132063
CountryCode: US
TelephoneNumber: 3022833300
FaxNumber: 3022833321
Practice Location
Address1: 316 ATLANTIC AVE
Address2:  
City: MILLVILLE
State: DE
PostalCode: 199676727
CountryCode: US
TelephoneNumber: 3026533557
FaxNumber: 3026533552
Other Information
ProviderEnumerationDate: 02/08/2007
LastUpdateDate: 03/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MAYES
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: B
AuthorizedOfficialTitleorPosition: CREDENTIALING SUPERVISOR
AuthorizedOfficialTelephone: 3022833300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
3416L0300X3677DEY Transportation ServicesAmbulanceLand Transport

No ID Information.


Home