Healthcare Provider Details

I. General information

NPI: 1760426860
Provider Name (Legal Business Name): TIOGA FIREMENS AMBULANCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RARICK DR.
TIOGA PA
16946
US

IV. Provider business mailing address

PO BOX 103
TIOGA PA
16946-0103
US

V. Phone/Fax

Practice location:
  • Phone: 570-835-5291
  • Fax:
Mailing address:
  • Phone: 570-835-5291
  • 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: WILLIAM M PRESTON
Title or Position: PRESIDENT
Credential:
Phone: 570-835-5291