Healthcare Provider Details

I. General information

NPI: 1891860060
Provider Name (Legal Business Name): SPRINGFIELD SPORTS EMERGENCY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 SAXER AVE
SPRINGFIELD PA
19064-2335
US

IV. Provider business mailing address

166 SAXER AVE
SPRINGFIELD PA
19064-2335
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-7262
  • Fax: 610-328-4440
Mailing address:
  • Phone: 610-328-7262
  • Fax: 610-328-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS012109
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS004263L
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT FONG SING
Title or Position: PRESIDENT
Credential: DO
Phone: 610-328-7262