1093713877 NPI number — JUNIATA VALLEY AMBULANCE SERVICE ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093713877 NPI number — JUNIATA VALLEY AMBULANCE SERVICE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUNIATA VALLEY AMBULANCE SERVICE ASSOCIATION
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:
1093713877
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 726
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CUMBERLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17070-0726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-214-6018
Provider Business Mailing Address Fax Number:
717-214-6020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7571 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16611-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-669-9539
Provider Business Practice Location Address Fax Number:
814-669-4880
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
BEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
814-669-9539

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04079 , 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: 001002725 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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