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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