Basic Information
| Provider Information | |||||||||
| NPI: | 1497081608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARYDEL VOLUNTEER FIRE CO, INC | ||||||||
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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: | 110 FIRE HOUSE LANE | ||||||||
| Address2: | |||||||||
| City: | MARYDEL | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199640400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026533557 | ||||||||
| FaxNumber: | 3026533552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 11/12/2012 | ||||||||
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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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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | DE | Y | Transportation Services | Ambulance | Land Transport |
No ID Information.