1932105293 NPI number — BETHLEHEM AMBULANCE ASSOCIATION INC

Table of content: (NPI 1932105293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932105293 NPI number — BETHLEHEM AMBULANCE ASSOCIATION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHLEHEM AMBULANCE ASSOCIATION 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:
1932105293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 401
Provider Second Line Business Mailing Address:
83 MAIN STREET SOUTH
Provider Business Mailing Address City Name:
BETHLEHEM
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06751-0401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-266-6666
Provider Business Mailing Address Fax Number:
203-266-5535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MAIN ST SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-266-6666
Provider Business Practice Location Address Fax Number:
203-266-6666
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARCH
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
203-266-7890

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  CT123 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 710C010AZCT01 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004224292 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: CU7382 . This is a "PHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00422429200 . This is a "BLUE CARE FAMILY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 709773 . This is a "CONNECTICARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com