Healthcare Provider Details

I. General information

NPI: 1083758684
Provider Name (Legal Business Name): GORDONVILLE FIRE COMPANY AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OLD LEACOCK AND VIGILANT STREETS
GORDONVILLE PA
17529
US

IV. Provider business mailing address

5925 TILGHMAN ST SUITE 1000
ALLENTOWN PA
18104-9156
US

V. Phone/Fax

Practice location:
  • Phone: 717-768-3869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRIS SPENNER
Title or Position: BILLING MANAGER
Credential:
Phone: 484-664-2007