Provider Demographics
NPI:1043202898
Name:SPRING GROVE AREA AMBULANCE CLUB
Entity Type:Organization
Organization Name:SPRING GROVE AREA AMBULANCE CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-739-8330
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-0726
Mailing Address - Country:US
Mailing Address - Phone:717-214-6018
Mailing Address - Fax:717-214-6020
Practice Address - Street 1:6115 THOMAN DR
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:PA
Practice Address - Zip Code:17362-9153
Practice Address - Country:US
Practice Address - Phone:717-739-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000873468Medicaid
PA000873468Medicaid