Healthcare Provider Details

I. General information

NPI: 1245486893
Provider Name (Legal Business Name): SPRINGBORO VOLUNTEER FIRE DEPT & RELIEF ASSN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 N MAIN ST
SPRINGBORO PA
16435-3304
US

IV. Provider business mailing address

176 N MAIN ST
SPRINGBORO PA
16435-3304
US

V. Phone/Fax

Practice location:
  • Phone: 814-587-3514
  • Fax: 814-587-2891
Mailing address:
  • Phone: 814-587-3514
  • Fax: 814-587-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier1022154900001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DAVID J BATES
Title or Position: PRESIDENT
Credential:
Phone: 814-587-3514