1982678504 NPI number — PERKASIE COMMUNITY AMBULANCE

Table of content: (NPI 1982678504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982678504 NPI number — PERKASIE COMMUNITY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERKASIE COMMUNITY 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:
1982678504
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 195
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERKASIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18944-0195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-257-9155
Provider Business Mailing Address Fax Number:
215-257-3300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 S 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERKASIE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18944-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-257-9155
Provider Business Practice Location Address Fax Number:
215-257-3300
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADDOX
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-257-9155

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  02034 , 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: 0748742000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0472184 . This is a "AETNA HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012354220002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30005909 . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0472184 . This is a "US HELATHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232748 . This is a "BLUECROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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