1730171596 NPI number — TWIN CREEKS COMMUNITY VOLUNTEER AMBULANCE SERVICE

Table of content: (NPI 1730171596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730171596 NPI number — TWIN CREEKS COMMUNITY VOLUNTEER AMBULANCE SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN CREEKS COMMUNITY VOLUNTEER AMBULANCE SERVICE
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:
1730171596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 726
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CUMBERLAND
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17070-0726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-214-6018
Provider Business Mailing Address Fax Number:
717-214-6020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4814 SHAVERS CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PETERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16669-3630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-667-3533
Provider Business Practice Location Address Fax Number:
814-667-3103
Provider Enumeration Date:
08/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
COFFMAN
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
814-667-3533

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  05213 , 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: 001633967 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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