MEDICARE: SPRING GROVE AREA AMBULANCE CLUB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	04014	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043202898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING GROVE AREA AMBULANCE CLUB

Provider Business Mailing Address
First Line	:	PO BOX 726
Second Line	:
City	:	NEW CUMBERLAND
State	:	PA
Zip	:	17070-0726
Country	:	US
Telephone Number	:	717-214-6018
Fax Number	:	717-214-6020

Provider Business Practice Location Address
First Line	:	6115 THOMAN DR
Second Line	:
City	:	SPRING GROVE
State	:	PA
Zip	:	17362-9153
Country	:	US
Telephone Number	:	717-739-8330
Fax Number	:

Authorized Official
Title or Position	:	EMS CHIEF
Name	:	JACQUELINE HEFFNER
Credential	:
Telephone Number	:	717-739-8330

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/09/2021

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