Provider Demographics
NPI:1679525331
Name:BLOSSBURG FIREMENS AMBULANCE ASSOCIATION, INC
Entity Type:Organization
Organization Name:BLOSSBURG FIREMENS AMBULANCE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-638-3366
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:BLOSSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16912-0002
Mailing Address - Country:US
Mailing Address - Phone:570-638-3366
Mailing Address - Fax:
Practice Address - Street 1:324 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOSSBURG
Practice Address - State:PA
Practice Address - Zip Code:16912-1156
Practice Address - Country:US
Practice Address - Phone:570-638-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA286033OtherHIGHMARK BLUE SHIELD
PA0007135800002Medicaid
PA078016OtherFIRST PRIORITY HEALTH
PA0007135800002Medicaid
PA286033Medicare PIN