Provider Demographics
NPI:1497726400
Name:SOUDERTON COMMUNITY AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:SOUDERTON COMMUNITY AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:215-723-3400
Mailing Address - Street 1:PO BOX 64214
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-0214
Mailing Address - Country:US
Mailing Address - Phone:215-723-3400
Mailing Address - Fax:215-723-1552
Practice Address - Street 1:223 WEST RELIANCE RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969
Practice Address - Country:US
Practice Address - Phone:215-723-3400
Practice Address - Fax:215-723-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-28
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0049080000OtherKEYSTONE EAST
10020074OtherKEYSTONE MERCY
07945OtherHEALTH PARTNERS
PA0011152820004Medicaid
59001268OtherRR MEDICARE
PA0011152820004Medicaid