1427129428 NPI number — BLANDON COMMUNITY AMBULANCE ASSN INC.

Table of content: LUCINDA CHARLOTTE BISHOP DIMAGGIO BIS (NPI 1205667300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427129428 NPI number — BLANDON COMMUNITY AMBULANCE ASSN INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLANDON COMMUNITY AMBULANCE ASSN 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:
1427129428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 258
Provider Second Line Business Mailing Address:
28 W WESNER ROAD
Provider Business Mailing Address City Name:
BLANDON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19510-9702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-926-7797
Provider Business Mailing Address Fax Number:
610-926-6048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 W WESNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLANDON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19510-9702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-926-7797
Provider Business Practice Location Address Fax Number:
610-926-6048
Provider Enumeration Date:
11/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF
Authorized Official Telephone Number:
610-926-7297

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  02189 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)