Provider Demographics
NPI:1881675676
Name:SOUTHERN CLARION COUNTY VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:SOUTHERN CLARION COUNTY VOLUNTEER AMBULANCE SERVICE
Other - Org Name:SOUTHERN CLARION COUNTY VOLUNTEER AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:VASBINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-473-6252
Mailing Address - Street 1:10515 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:RIMERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16248-7005
Mailing Address - Country:US
Mailing Address - Phone:814-473-6252
Mailing Address - Fax:814-473-9830
Practice Address - Street 1:10515 ROUTE 68
Practice Address - Street 2:
Practice Address - City:RIMERSBURG
Practice Address - State:PA
Practice Address - Zip Code:16248-7005
Practice Address - Country:US
Practice Address - Phone:814-473-6252
Practice Address - Fax:814-473-9830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CLARION COUNTY VOLUNTEER AMBULANCE SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-08
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03020341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016184080004Medicaid
441590468OtherPALMETTO/RR MEDICARE
PA0016184080004Medicaid