1639199144 NPI number — JIM THORPE EMS

Table of content: (NPI 1639199144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639199144 NPI number — JIM THORPE EMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIM THORPE 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:
1639199144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4096
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JIM THORPE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18229-4096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-325-4806
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JIM THORPE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-325-4806
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAGER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-325-4806

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  05179 , 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: 3777775 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016621630005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35946 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".