1306996244 NPI number — WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC

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 1306996244 NPI number — WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC
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:
1306996244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2398
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18703-2398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-601-9881
Provider Business Mailing Address Fax Number:
570-825-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 ROSE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-5952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-825-2317
Provider Business Practice Location Address Fax Number:
570-829-6448
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HONTZ
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALVIN
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
570-825-2317

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  40220 , 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: 2088016000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8191213 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2088016000 . This is a "AMERIHELATH INC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30012666 . This is a "KEYSTON MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000137400 . This is a "UNISON HEALTH PLAN OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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