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Organization

FIREMENS AMB SERVICE TEAM

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CRYSTAL LOUISE GROVE (PRESIDENT)
(570) 923-1446
Entity
Organization

Contact information

Practice address
8TH AND HURRON AVE, RENOVA, PA 17764
(570) 923-1446
Mailing address
PO BOX 207, ALLENTOWN, PA 18105-0207
(800) 473-2278

Taxonomy

Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
18005
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0006999370004
PA
01
50013768
CAPITAL BLUE CROSS BASIC
Enumeration date
09/23/2005
Last updated
08/22/2020
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