Organization
SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1
Active
Organization
SLOCUM TOWNSHIP VOLUNTEER FIRE COMPANY NO 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE M WIATEROWSKI JR. (EMS CAPTAIN/BILLING OFFICER)
(570) 868-6255
Entity
Organization
Contact information
Practice address
1923 SLOCUM RD, WAPWALLOPEN, PA 18660-8886
(570) 868-6255
(570) 868-3815
Mailing address
1923 SLOCUM RD, WAPWALLOPEN, PA 18660-8886
(570) 868-6255
(570) 868-3815
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083364100
FEDERAL BLACK LUNG PROG
PA
05
—
1011294690001
—
PA
01
—
248702
HIGHMARK BS
PA
01
—
998571
BLUE CROSS NEPA
PA
Enumeration date
07/24/2006
Last updated
02/11/2013
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