Basic Information
| Provider Information | |||||||||
| NPI: | 1861488835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE COCHRANTON VOLUNTEER FIRE DEPARTMENT AND RELIEF ASSOCIATION | ||||||||
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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: | 113 E ADAMS ST | ||||||||
| Address2: | |||||||||
| City: | COCHRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163148603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144252111 | ||||||||
| FaxNumber: | 8144251303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 12/20/2012 | ||||||||
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| AuthorizedOfficialLastName: | STOCKTON | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | JANE | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 8144252111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 04024 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0008347910004 | 05 | PA | MEDICAID | 0589370 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 590130902 | 01 | UNITED HC RR MEDICARE | OTHER | 609293700 | 01 | DEPT OF LABOR WORK COMP | OTHER | 217128 | 01 | UPMC HEALTH PLAN COMMERIC | OTHER | 287231 | 01 | BCBS OF PA BLUE SHIELD | OTHER |