1518910827 NPI number — COTTAGE HOSE AMBULANCE CORP INC

Table of content: (NPI 1518910827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518910827 NPI number — COTTAGE HOSE AMBULANCE CORP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COTTAGE HOSE AMBULANCE CORP 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:
1518910827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 331
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARBONDALE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18407-0331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-282-4649
Provider Business Mailing Address Fax Number:
570-282-5653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 GREENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-282-4649
Provider Business Practice Location Address Fax Number:
570-282-5653
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-282-5654

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04263 , 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: 072995 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1200740 . This is a "PDA WAIVER PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 246774 . This is a "BC NEPA ACCESSCARE 2" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 287142 . This is a "STERLING OPTION 1" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 246774 . This is a "FERERAL EMPLOYEES CLAIMS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 246774 . This is a "FREDOM BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1200740 . This is a "HEALTHMATE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20013102 . This is a "AMERI HEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A1310245 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012860 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 246774 . This is a "BLUE CROSS BLUE CARD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 287142 . This is a "PRISON HEALTH SYSTEM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 998502 . This is a "BC MAJOR MEDICAL NEBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1531307 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012007400001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246774 . This is a "BC BS SECURITY 65" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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