1548264427 NPI number — AMERICAN LEGION AMBULANCE STATION 64 INC

Table of content: (NPI 1548264427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548264427 NPI number — AMERICAN LEGION AMBULANCE STATION 64 INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN LEGION AMBULANCE STATION 64 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:
DCH POST 14 AMERICAN LEGION AMBULANCE STATION 64 INC
Provider Other Organization Name Type Code:
5
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:
1548264427
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 SMYRNA CLAYTON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMYRNA
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19977-0345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-653-6465
Provider Business Mailing Address Fax Number:
302-653-9342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SMYRNA CLAYTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977-0345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-653-6465
Provider Business Practice Location Address Fax Number:
302-653-9342
Provider Enumeration Date:
06/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POST
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
AMB SERVICE DIRECTOR
Authorized Official Telephone Number:
302-653-6465

Provider Taxonomy Codes

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

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

  • Identifier: 0000496015 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".