Provider Demographics
NPI:1891860060
Name:SPRINGFIELD SPORTS EMERGENCY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SPRINGFIELD SPORTS EMERGENCY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FONG
Authorized Official - Last Name:SING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-328-7262
Mailing Address - Street 1:166 SAXER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2335
Mailing Address - Country:US
Mailing Address - Phone:610-328-7262
Mailing Address - Fax:610-328-4440
Practice Address - Street 1:166 SAXER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2335
Practice Address - Country:US
Practice Address - Phone:610-328-7262
Practice Address - Fax:610-328-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004263L207QS0010X
PAOS012109207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007120910012Medicaid
PA0007120910012Medicaid