1801950662 NPI number — BARRETT TOWNSHIP AMBULANCE CORPS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801950662 NPI number — BARRETT TOWNSHIP AMBULANCE CORPS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRETT TOWNSHIP AMBULANCE CORPS, 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:
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:
1801950662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESCO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18326-0105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-595-7621
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROUTE 191
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAINHOME
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-595-7621
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MICK
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
570-595-7621

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: 335965 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007002140001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 998526 . This is a "BLUE CROSS NEPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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