Provider Demographics
NPI:1023195179
Name:NORTHEAST PARAMEDIC SERVICES INC
Entity Type:Organization
Organization Name:NORTHEAST PARAMEDIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PROHASKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-718-6980
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0830
Mailing Address - Country:US
Mailing Address - Phone:570-718-6980
Mailing Address - Fax:570-718-6983
Practice Address - Street 1:273 UNION ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1411
Practice Address - Country:US
Practice Address - Phone:570-718-6980
Practice Address - Fax:570-718-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03353341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225245OtherHIGHMARK
PA0018390300004Medicaid
PA998560OtherBLUE CROSS
PA998560OtherBLUE CROSS