Provider Demographics
NPI:1043206014
Name:KINGSTON FIREMENS COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:KINGSTON FIREMENS COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-714-0471
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:484-664-2007
Mailing Address - Fax:
Practice Address - Street 1:600 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3702
Practice Address - Country:US
Practice Address - Phone:570-714-0471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0012514170001OtherPA MEDICAID
0X00PA7945OtherPHS HEALTH PLAN HMO MDC
20010720OtherAMERIHEALTH MERCY HMO DPA
214314OtherBCNE CONTRACT CLAIMS
590011415OtherUNITED HC RR MEDICARE
117946600OtherACS HEALTH NET COMMERCIAL
117946600OtherACS HEALTH NET HMO MDC
117946600OtherACS BENEFITS
892993OtherUMWA HEALTH & RETIREMENT
0110819OtherAETNA USHC BLUE BELL HMO
080783OtherFIRST PRIORITY HEALTH
0X00PA7945OtherPHS HEALTH PLAN COMMERCIA
0X00PA7945OtherQUALMED
214314OtherBC BS OF PA BLUE SHIELD
214314OtherBC OF NE PA
214314OtherBC BS OF PA BLUE SHIELD