Organization
JOPPA MAGNOLIA VOLUNTEER FIRE CO. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT W RUSSELL (PRESIDENT)
(410) 679-1055
Entity
Organization
Contact information
Practice address
1403 OLD MOUNTAIN ROAD S, JOPPA, MD 21085-3103
(410) 679-1055
(410) 679-3420
Mailing address
1403 OLD MOUNTAIN ROAD S, JOPPA, MD 21085-3103
(410) 679-1055
(410) 679-3420
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
590008873
RAILROAD MEDICARE PIN
MD
05
—
914550800
—
MD
01
—
T413
FEDERAL BLUE SHIELD
MD
01
—
Y938
CAREFIRST BLUE CROSS/BLUE SHIELD
MD
Enumeration date
08/31/2006
Last updated
11/14/2011
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