Provider Demographics
NPI:1730167834
Name:BROOKSIDE VOLUNTEER FIRE COMPANY
Entity type:Organization
Organization Name:BROOKSIDE VOLUNTEER FIRE COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-889-3820
Mailing Address - Street 1:3560 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-3012
Mailing Address - Country:US
Mailing Address - Phone:814-899-3820
Mailing Address - Fax:814-899-1479
Practice Address - Street 1:3560 ATHENS ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-3012
Practice Address - Country:US
Practice Address - Phone:814-899-3820
Practice Address - Fax:814-899-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010890570003Medicaid
PA1501732OtherGATEWAY HEALTH PLAN
PA0010890570001Medicaid
PA250344OtherUPMC HEALTH
PA590011960OtherRR MEDICARE/PALMETTO GBA
PA339394OtherHEALTH AMERICA
PA285123OtherBLUE CROSS/BLUE SHIELD
PA285123OtherBLUE CROSS/BLUE SHIELD
PA590011960OtherPALMETTO GBA