1255456968 NPI number — SOUTH FORK AMBULANCE ASSOCIATION

Table of content: (NPI 1255456968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255456968 NPI number — SOUTH FORK AMBULANCE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH FORK AMBULANCE ASSOCIATION
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:
1255456968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2011
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28 MALL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH FORK
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-473-2278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BRYD
Authorized Official First Name:
TERI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
719-852-2362

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 826590682 . This is a "RR MEDICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 06000749 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 840765177 . This is a "TRICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: S063893 . This is a "BS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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