1255336152 NPI number — NORVELT EMERGENCY MEDICAL SERVICE

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 1255336152 NPI number — NORVELT EMERGENCY MEDICAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORVELT EMERGENCY MEDICAL SERVICE
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:
6
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:
1255336152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 195
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORVELT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15674-0195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-423-7044
Provider Business Mailing Address Fax Number:
724-423-1220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2265 MT. PLEASANT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-423-7044
Provider Business Practice Location Address Fax Number:
724-423-1220
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JANOS
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
LEIGH
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
724-423-7044

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  98269 , 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: 18844 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590010375 . This is a "UMWA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200397 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590010375 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010151420002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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