1417088436 NPI number — WASHINGTON TOWNSHIP AMBULANCE ASSOCIATION

Table of content: (NPI 1417088436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417088436 NPI number — WASHINGTON TOWNSHIP AMBULANCE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON TOWNSHIP 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:
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:
1417088436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1016
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-7016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-784-3715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 WILLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TURNERSVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08012-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-232-6151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
GM
Authorized Official Telephone Number:
856-228-5995

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  WASH00626 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 116320500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 91000324400 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0712649000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 590013044 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1087133 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0712649000 . This is a "KEYSTONE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2065390 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 33172 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0075673210002 . This is a "PENNSYLVANIA MEDICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7769709 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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