Healthcare Provider Details

I. General information

NPI: 1710966502
Provider Name (Legal Business Name): AVONDALE FIRE COMPANY EMS DIVISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 FIREHOUSE WAY
AVONDALE PA
19311-1418
US

IV. Provider business mailing address

23 FIREHOUSE WAY
AVONDALE PA
19311-1418
US

V. Phone/Fax

Practice location:
  • Phone: 610-268-2486
  • Fax: 610-268-3573
Mailing address:
  • Phone: 610-268-2486
  • Fax: 610-268-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN NUSE
Title or Position: EMS SUPERVISOR
Credential:
Phone: 610-268-2486