Basic Information
| Provider Information | |||||||||
| NPI: | 1467427906 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOCKESSIN FIRE COMPANY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 71 OMEGA DR | ||||||||
| Address2: | BUILDING D | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022833300 | ||||||||
| FaxNumber: | 3022833321 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 OLD LANCASTER PIKE | ||||||||
| Address2: | |||||||||
| City: | HOCKESSIN | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197079560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3022833300 | ||||||||
| FaxNumber: | 3022833321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 01/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | MAYES | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3022833300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 1GBE4V1246F404758 | DE | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 0000622615 | 05 | DE | MEDICAID |