Provider Demographics
NPI:1033284245
Name:DURYEA AMBULANCE AND RESCUE SERVICE ASSOC
Entity Type:Organization
Organization Name:DURYEA AMBULANCE AND RESCUE SERVICE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BODOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-237-7348
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-0846
Mailing Address - Country:US
Mailing Address - Phone:570-714-3694
Mailing Address - Fax:570-714-3695
Practice Address - Street 1:261 MARCY ST
Practice Address - Street 2:
Practice Address - City:DURYEA
Practice Address - State:PA
Practice Address - Zip Code:18642-1352
Practice Address - Country:US
Practice Address - Phone:570-451-0404
Practice Address - Fax:570-451-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051583416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014387570003Medicaid
PA0014387570003Medicaid