Healthcare Provider Details

I. General information

NPI: 1114910452
Provider Name (Legal Business Name): JEFFERSON VOLUNTEER FIRE CO AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 JEFFERSON RD
JEFFERSON PA
15344-4154
US

IV. Provider business mailing address

PO BOX 236
JEFFERSON PA
15344-0236
US

V. Phone/Fax

Practice location:
  • Phone: 724-883-3901
  • Fax: 724-883-3903
Mailing address:
  • Phone: 724-833-3901
  • Fax: 724-883-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04215
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0010590020002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: TODD SNYDER
Title or Position: EMS DIRECTOR
Credential:
Phone: 724-883-3901