Provider Demographics
NPI:1023030939
Name:PIKE COUNTY ADVANCED LIFE SUPPORT INC
Entity Type:Organization
Organization Name:PIKE COUNTY ADVANCED LIFE SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-828-2225
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-0384
Mailing Address - Country:US
Mailing Address - Phone:570-296-2580
Mailing Address - Fax:570-832-2164
Practice Address - Street 1:149 SAWKILL AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1141
Practice Address - Country:US
Practice Address - Phone:570-296-2580
Practice Address - Fax:570-832-2164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015389420002Medicaid
PA1015389420002Medicaid
PA077713Medicare PIN