1912995747 NPI number — MOUNTAINTP COMMUNITY AMBULANCE

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 1912995747 NPI number — MOUNTAINTP COMMUNITY AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAINTP COMMUNITY AMBULANCE
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:
1912995747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18105-0207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-664-2007
Provider Business Mailing Address Fax Number:
484-664-2015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RTE 437-309
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN TOP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-474-2513
Provider Business Practice Location Address Fax Number:
570-474-2513
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERRON
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER/DIRECTOR
Authorized Official Telephone Number:
570-474-9751

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0X00PA0847 . This is a "QUALMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0597142 . This is a "AETNA USHC BLUE BELL HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00PA0847 . This is a "ACS HEALTHNET HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00PA0847 . This is a "PHS HEALTH PLAN COMMERCIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0014802690003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0X00PA0847 . This is a "PHS HEALTH PLAN HMO MDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 590008832 . This is a "UNITED HC RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0X00PA0847 . This is a "ACS HEALTHNET COMMERCIAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1587077 . This is a "BCBS OF NE PA ACESS CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 225955 . This is a "BC BS OF PA BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 077070 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".




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