Provider Demographics
NPI:1316937469
Name:GOOD FELLOWSHIP CLUB OF CHESTER COUNTY, INC.
Entity type:Organization
Organization Name:GOOD FELLOWSHIP CLUB OF CHESTER COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOSSERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-431-8780
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19381-0361
Mailing Address - Country:US
Mailing Address - Phone:610-431-3132
Mailing Address - Fax:610-840-0415
Practice Address - Street 1:600 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4429
Practice Address - Country:US
Practice Address - Phone:610-431-3132
Practice Address - Fax:610-840-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03056341600000X
PA060343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007127520001Medicaid
PA280786Medicare UPIN