Provider Demographics
NPI:1558364950
Name:CONCORDVILLE FIRE AND PROTECTIVE ASSOCIATION
Entity Type:Organization
Organization Name:CONCORDVILLE FIRE AND PROTECTIVE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-464-0724
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CONCORDVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19331-0070
Mailing Address - Country:US
Mailing Address - Phone:610-459-4749
Mailing Address - Fax:
Practice Address - Street 1:854 CONCORD ROAD
Practice Address - Street 2:
Practice Address - City:CONCORDVILLE
Practice Address - State:PA
Practice Address - Zip Code:19331-0070
Practice Address - Country:US
Practice Address - Phone:610-459-4749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033513416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000853797Medicaid
PA000853797Medicaid