Provider Demographics
NPI:1700931649
Name:SWARTHMORE FIRE AND PROTECTIVE ASSOCIATION
Entity Type:Organization
Organization Name:SWARTHMORE FIRE AND PROTECTIVE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:CONLEN
Authorized Official - Middle Name:MERRYMAN
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-544-2732
Mailing Address - Street 1:PO BOX 1469
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-8469
Mailing Address - Country:US
Mailing Address - Phone:610-532-9444
Mailing Address - Fax:610-565-3288
Practice Address - Street 1:121 PARK AVE
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081
Practice Address - Country:US
Practice Address - Phone:610-544-2732
Practice Address - Fax:610-543-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05036341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017535620001Medicaid
PA027058Medicare ID - Type Unspecified