Provider Demographics
NPI:1285785402
Name:SPRINGFIELD AMBULANCE CORPS
Entity type:Organization
Organization Name:SPRINGFIELD AMBULANCE CORPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-328-3090
Mailing Address - Street 1:201 SAXER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-3143
Mailing Address - Country:US
Mailing Address - Phone:610-328-3090
Mailing Address - Fax:610-705-3979
Practice Address - Street 1:201 SAXER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3143
Practice Address - Country:US
Practice Address - Phone:610-328-3090
Practice Address - Fax:610-705-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA034043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001262063002Medicaid
PA284507OtherPTAN
PA0033270000OtherKEYSTONE EAST
PA0033270000OtherIND BLUE CROSS
PA590011607OtherRR MEDICARE
PA46370Medicaid