Basic Information
| Provider Information | |||||||||
| NPI: | 1346286572 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PULASKI TOWNSHIP VOLUNTEER FIRE DEPARTMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846642007 | ||||||||
| FaxNumber: | 4846642015 | ||||||||
| Practice Location | |||||||||
| Address1: | 3535 EVERGREEN RD | ||||||||
| Address2: | |||||||||
| City: | PULASKI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245101998 | ||||||||
| FaxNumber: | 7249648334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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| AuthorizedOfficialLastName: | LEASURE | ||||||||
| AuthorizedOfficialFirstName: | MINDY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | AMBULANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7245101998 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 02221 | PA | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 0010279020001 | 05 | PA | MEDICAID |