1962538900 NPI number — COMMUNITY AMBULANCE SERVICE CLUB

Table of content: (NPI 1962538900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962538900 NPI number — COMMUNITY AMBULANCE SERVICE CLUB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY AMBULANCE SERVICE CLUB
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:
1962538900
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 33
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWER CITY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17980-0033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-647-2271
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
633 EAST COLLIERY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWER CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-943-8013
Provider Business Practice Location Address Fax Number:
717-647-2546
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEITER
Authorized Official First Name:
JEREMIAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-943-8013

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  04141 , 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: 590007322 . This is a "RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012143980004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50004678 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0130130 . This is a "THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50004678 . This is a "KEYSTONE SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 893120 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 20018661 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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