1275650939 NPI number — ORWIGSBURG AMBULANCE INC

Table of content: (NPI 1275650939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275650939 NPI number — ORWIGSBURG AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORWIGSBURG AMBULANCE 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:
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:
1275650939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORWIGSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17961-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-366-2331
Provider Business Mailing Address Fax Number:
570-366-0519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORWIGSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17961-2050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-366-2331
Provider Business Practice Location Address Fax Number:
570-366-0519
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
BOARD OF DIRECTORS PRESIDENT
Authorized Official Telephone Number:
570-739-4456

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04045 , 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: 0007318920003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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