Organization
ELGIN BEAVERDAM HOSE CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSANNA AKAM (TREASURER)
(814) 664-4140
Entity
Organization
Contact information
Practice address
17920 NORTH MAIN ST., BOX 51, ELGIN, PA 16413-0051
(814) 664-4140
(814) 664-4140
Mailing address
PO BOX 51, 17920 NORTH MIAN ST., ELGIN, PA 16413-0051
(814) 664-4140
(814) 664-4140
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
04053
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010429360003
—
PA
01
—
288273
BLUE CROSS/BLUE SHIELD
PA
Enumeration date
01/09/2006
Last updated
09/10/2012
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