1669468732 NPI number — LARKSVILLE COMMMUNITY AMBULANCE

Table of content: (NPI 1669468732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669468732 NPI number — LARKSVILLE COMMMUNITY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARKSVILLE COMMMUNITY AMBULANCE
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:
1669468732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
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:
484-664-2015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 E STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARKSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18651-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-779-4778
Provider Business Practice Location Address Fax Number:
570-779-4828
Provider Enumeration Date:
09/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENSON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CAPTAIN
Authorized Official Telephone Number:
570-779-4828

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03372 , 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: 0471301 . This is a "AETNA USHC BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 080816 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "ACS HEALTH NET HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "PHS HEALTH PLAN HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "ACS HEALTH NET COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0015286200003 . This is a "PA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222759 . This is a "BC BS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 811529 . This is a "UMWA HEALTH & RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "PHS HEALTH PLAN COMMERCIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PB4425 . This is a "QUALMED" identifier . This identifiers is of the category "OTHER".




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