1669468732 NPI number — LARKSVILLE COMMMUNITY AMBULANCE

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 1669468732 NPI number — LARKSVILLE COMMMUNITY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARKSVILLE COMMMUNITY AMBULANCE
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:
1669468732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-664-2007
Provider Business Mailing Address Fax Number:
484-664-2015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARKSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18651-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-779-4778
Provider Business Practice Location Address Fax Number:
570-779-4828
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENSON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CAPTAIN
Authorized Official Telephone Number:
570-779-4828

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03372 , 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: 0471301 . This is a "AETNA USHC BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080816 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "ACS HEALTH NET HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "PHS HEALTH PLAN HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "ACS HEALTH NET COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0015286200003 . This is a "PA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222759 . This is a "BC BS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 811529 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "PHS HEALTH PLAN COMMERCIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "QUALMED" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com