1205837267 NPI number — POTTSVILLE AREA EMERGENCY MEDICAL SERVICES, INC.

Table of content: (NPI 1205837267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205837267 NPI number — POTTSVILLE AREA EMERGENCY MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POTTSVILLE AREA EMERGENCY MEDICAL SERVICES, 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:
6
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:
1205837267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 N 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POTTSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17901-2346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-622-9647
Provider Business Mailing Address Fax Number:
570-622-9648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 N 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTTSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17901-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-622-9647
Provider Business Practice Location Address Fax Number:
570-622-9648
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LAUBACH
Authorized Official First Name:
GARRY
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
570-622-9647

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: 080249800 . This is a "FEDERAL BLACK LUNG PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 34971 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503196 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 216669 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50004344 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0013964500005 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P023290 . This is a "TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20010626 . This is a "AMERIHEALTH CARITAS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 30009167 . This is a "KEYSTONE MERCY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080249800 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 653509 . This is a "VICTIM'S COMPENSATION" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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