Organization
CHINCHILLA HOSE COMPANY OF SOUTH ABINGTON TOWNSHIP
Active
Organization
CHINCHILLA HOSE COMPANY OF SOUTH ABINGTON TOWNSHIP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DOUGHERTY (PRESIDENT)
(570) 586-5626
Entity
Organization
Contact information
Practice address
113 SHADY LANE RD, SOUTH ABINGTON TOWNSHIP, PA 18411-9020
(570) 586-5726
(570) 587-2008
Mailing address
113 SHADY LANE RD, SOUTH ABINGTON TOWNSHIP, PA 18411-9020
(570) 586-5726
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
35004
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012904890001
—
PA
01
—
081105900
FEDERAL BLUE CROSS
PA
01
—
590009247
RAILROAD MEDICARE
PA
Enumeration date
03/15/2007
Last updated
08/03/2021
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