1730286162 NPI number — FOREST CITY AREA VOLUNTEER AMBULANCE ASSOCIATION

Table of content: (NPI 1730286162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730286162 NPI number — FOREST CITY AREA VOLUNTEER AMBULANCE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREST CITY AREA VOLUNTEER 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:
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:
1730286162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 151
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18421-0151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-785-5025
Provider Business Mailing Address Fax Number:
570-785-2369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 DELAWARE STREET REAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18421-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-785-5025
Provider Business Practice Location Address Fax Number:
570-785-2369
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-785-5025

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04309 , 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: 075242 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30447 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007657830002 . This is a "UNISON -THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007657830002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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