Healthcare Provider Details

I. General information

NPI: 1245211697
Provider Name (Legal Business Name): ONSITE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 CONCORD RD SUITE A
ASTON PA
19014-2947
US

IV. Provider business mailing address

2960 CONCORD RD SUITE A
ASTON PA
19014-2947
US

V. Phone/Fax

Practice location:
  • Phone: 717-464-0724
  • Fax:
Mailing address:
  • Phone: 717-464-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03362
License Number StatePA

VIII. Authorized Official

Name: DANIEL C ROTH
Title or Position: BILLING
Credential:
Phone: 717-464-0724