1316097462 NPI number — PLYMOUTH BOROUGH AMBULANCE ASSOC. INC.

Table of content: (NPI 1316097462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316097462 NPI number — PLYMOUTH BOROUGH AMBULANCE ASSOC. INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLYMOUTH BOROUGH AMBULANCE ASSOC. 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:
1316097462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 GAYLORD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18651-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-779-9878
Provider Business Mailing Address Fax Number:
570-779-4666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 GAYLORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18651-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-779-9878
Provider Business Practice Location Address Fax Number:
570-779-4666
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-779-4388

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  04175 , 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: 2165244 . This is a "AETNA USHC BLUE BELL HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590014556 . This is a "UNITED HC RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0019186260001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 808300 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080026400 . This is a "FEDERAL BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7879 . This is a "PHS HEALTH PLAN COMMERCIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 201756 . This is a "BC BS OF PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7879 . This is a "ACS HEALTH NET HMO MDC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7879 . This is a "PHS HEALTH PLAN HMO MDC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7879 . This is a "QUALMED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30013904 . This is a "KEYSTONE MERCY HMO DPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: PA7879 . This is a "ACS HEALTH NET COMMERCIAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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