1821176892 NPI number — CHARLES J. SPELLMAN AMBULANCE SERVICE, INC.

Table of content: (NPI 1821176892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821176892 NPI number — CHARLES J. SPELLMAN AMBULANCE SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES J. SPELLMAN AMBULANCE SERVICE, 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:
1821176892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 MARION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUZERNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18709-1419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-822-5587
Provider Business Mailing Address Fax Number:
570-287-3384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 MARION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUZERNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18709-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-5587
Provider Business Practice Location Address Fax Number:
570-287-3384
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERLEW
Authorized Official First Name:
HOMER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
570-822-5587

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  04051 , 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: 200510 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 805657 . This is a "FIRST PRIORITY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CJ200510 . This is a "MEDICARE TRAVELERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0014501800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30230362S . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CJ200510 . This is a "STERLING" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 080008300 . This is a "BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 568281 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 84067 . This is a "THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 998506 . This is a "BLUE CROSS NEPA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CJ200510 . This is a "FEDERAL BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20005603 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200510 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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