1891137568 NPI number — SCRANTON QUINCY AMBULANCE LLC

Table of content: (NPI 1891137568)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891137568 NPI number — SCRANTON QUINCY AMBULANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCRANTON QUINCY AMBULANCE LLC
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:
COMMONWEALTH HEALTH EMS
Provider Other Organization Name Type Code:
3
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:
1891137568
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 MERIDIAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-6325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-465-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 REMINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCRANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18505-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-558-4911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SENIOR DIRECTOR, ENROLLMENT
Authorized Official Telephone Number:
877-892-9815

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  13016 , 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: P01264050 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102878813 0004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 831195 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".