1073509147 NPI number — MOUNT MORRIS EMS

Table of content: (NPI 1073509147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073509147 NPI number — MOUNT MORRIS EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT MORRIS EMS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073509147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-664-2007
Provider Business Mailing Address Fax Number:
484-664-2015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MAIN ST
Provider Second Line Business Practice Location Address:
AMERICAN LEGION HALL
Provider Business Practice Location Address City Name:
MT MORRIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-324-2041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-324-5212

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0014463100004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219279 . This is a "BCBS OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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