1700983962 NPI number — MUHLENBERG AREA AMBULANCE ASSOCIATION INCORPORATED

Table of content: DR. JOHN MENDEZ PH.D., LCSW, CAP (NPI 1942387972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700983962 NPI number — MUHLENBERG AREA AMBULANCE ASSOCIATION INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUHLENBERG AREA AMBULANCE ASSOCIATION INCORPORATED
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:
1700983962
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19560-0206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-929-5774
Provider Business Mailing Address Fax Number:
610-929-7965

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 E BELLEVUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
READING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19605-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-929-5774
Provider Business Practice Location Address Fax Number:
610-929-7965
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIPE
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
610-929-5774

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  06109 , 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)





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