Healthcare Provider Details

I. General information

NPI: 1801961040
Provider Name (Legal Business Name): EDWARDSVILLE VOLUNTEER FIREMENS COMMUNITY AMBULANCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 MAIN ST
EDWARDSVILLE PA
18704-3275
US

IV. Provider business mailing address

470 MAIN ST
EDWARDSVILLE PA
18704-3275
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-8464
  • Fax:
Mailing address:
  • Phone: 570-288-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RONALD S LEONARD
Title or Position: PRESIDENT
Credential:
Phone: 570-288-8464