1255336152 NPI number — NORVELT EMERGENCY MEDICAL SERVICE

Table of content: (NPI 1255336152)

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:
NORVELT 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:
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".