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Organization

TOWNSHIP OF LOGAN

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANDY LOVELL (CHIEF)
(856) 241-9100
Entity
Organization

Contact information

Practice address
125 MAIN ST, BRIDGEPORT, NJ 08014
(856) 241-9100
Mailing address
PO BOX 1016, VOORHEES, NJ 08043-7016
(856) 784-3715

Taxonomy

Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
LOGA002
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0722897000
KEYSTONE
NJ
01
1126280
HORIZON NJ HEALTH
NJ
01
2368093
AETNA
NJ
05
8356602
NJ
01
91000095400
AMERICHOICE
NJ
01
P00079795
RAILROAD MEDICARE
NJ
Enumeration date
03/09/2007
Last updated
08/22/2020
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