1306996244 NPI number — WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC

Table of content: (NPI 1306996244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306996244 NPI number — WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC
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:
1306996244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18703-2398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-601-9881
Provider Business Mailing Address Fax Number:
570-825-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ROSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-5952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-2317
Provider Business Practice Location Address Fax Number:
570-829-6448
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HONTZ
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALVIN
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
570-825-2317

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  40220 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2088016000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8191213 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2088016000 . This is a "AMERIHELATH INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30012666 . This is a "KEYSTON MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000137400 . This is a "UNISON HEALTH PLAN OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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