1720063860 NPI number — NORTHERN VALLEY EMERGENCY MEDICAL SERVICES INC

Table of content: (NPI 1720063860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720063860 NPI number — NORTHERN VALLEY EMERGENCY MEDICAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN VALLEY EMERGENCY MEDICAL SERVICES 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:
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:
1720063860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2375 LEVANS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPLAY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18037-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-262-1075
Provider Business Mailing Address Fax Number:
610-262-8630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2375 LEVANS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPLAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18037-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-262-1075
Provider Business Practice Location Address Fax Number:
610-262-8630
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRENEISER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
610-262-1075

Provider Taxonomy Codes

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

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

  • Identifier: 1505976 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017025720001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1067558 . This is a "AMERIHEALTH CARITAS/NORTHEAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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