=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356558910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HADDONFIELD AMBULANCE ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2007
-----------------------------------------------------
Last Update Date | 12/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 N HADDON AVE
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-429-4308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1016
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-7016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-784-3715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN
-----------------------------------------------------
Name | KEVIN MACDONALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-429-4308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | HDNF04001
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------