Provider Demographics
NPI:1134266141
Name:SAINT CLAIR VETERANS MEMORIAL AMBULANCE FUND
Entity type:Organization
Organization Name:SAINT CLAIR VETERANS MEMORIAL AMBULANCE FUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-429-1388
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:17970-0124
Mailing Address - Country:US
Mailing Address - Phone:570-429-1388
Mailing Address - Fax:570-429-0655
Practice Address - Street 1:45 N 2ND ST # 47
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:PA
Practice Address - Zip Code:17970-1027
Practice Address - Country:US
Practice Address - Phone:570-429-1388
Practice Address - Fax:570-429-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012172640004Medicaid
PA50003036OtherCAPITAL BLUE CROSS
PA441590643OtherPALMETTO GBA RAILROAD MED
PA283398OtherHIGHMARK BLUE SHIELD
PA441590643OtherPALMETTO GBA RAILROAD MED