Provider Demographics
NPI:1003985920
Name:SWOYERSVILLE POLICE COMMUNITY AMBULANCE ASSOCIATION INC.
Entity Type:Organization
Organization Name:SWOYERSVILLE POLICE COMMUNITY AMBULANCE ASSOCIATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-760-7320
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0830
Mailing Address - Country:US
Mailing Address - Phone:570-718-6980
Mailing Address - Fax:570-718-6983
Practice Address - Street 1:253 OWEN ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-2207
Practice Address - Country:US
Practice Address - Phone:570-287-8360
Practice Address - Fax:570-718-6503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04189341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011940430002Medicaid
PA202346Medicare ID - Type Unspecified