=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710973789
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWTOWN SQUARE FIRE CO AMB
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 N NEWTOWN SQUARE RD
-----------------------------------------------------
City | NEWTOWN SQUARE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-356-9916
-----------------------------------------------------
Fax | 610-356-9517
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 182
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-0182
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-464-0724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT W BLITHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 610-356-9916
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 06129
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------