1063574978 NPI number — DANVILLE AMBULANCE SERVICE, INCORPORATED

Table of content: (NPI 1063574978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063574978 NPI number — DANVILLE AMBULANCE SERVICE, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANVILLE AMBULANCE SERVICE, INCORPORATED
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:
1063574978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17821-0175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-275-6025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 A ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17821-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-275-6025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYNN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
570-275-6025

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0009418800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148859FY . This is a "PREFERRED CARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 602785000 . This is a "US DEPT. OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 335455 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 086106600 . This is a "FEDERAL BLACK LUNG PROG." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 280760 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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