MEDICARE: CHINCHILLA HOSE COMPANY OF SOUTH ABINGTON TOWNSHIP

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	341600000X	Ambulance
2	3416L0300X	Land Ambulance	35004	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590009247	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	081105900	OTHER	PA	FEDERAL BLUE CROSS

General Provider Information

NPI Number	:	1043344674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINCHILLA HOSE COMPANY OF SOUTH ABINGTON TOWNSHIP

Provider Business Mailing Address
First Line	:	113 SHADY LANE RD
Second Line	:
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-9020
Country	:	US
Telephone Number	:	570-586-5726
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SHADY LANE RD
Second Line	:
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-9020
Country	:	US
Telephone Number	:	570-586-5726
Fax Number	:	570-587-2008

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK DOUGHERTY
Credential	:
Telephone Number	:	570-586-5626

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/03/2021

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Directions to “CHINCHILLA HOSE COMPANY OF SOUTH ABINGTON TOWNSHIP ” Practice Location

Language	Start Address	Practice Location

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