Provider Demographics
NPI:1043228869
Name:BETHEL COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:BETHEL COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYLVAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WITMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-933-8934
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:PA
Mailing Address - Zip Code:19507-0032
Mailing Address - Country:US
Mailing Address - Phone:717-933-8934
Mailing Address - Fax:717-933-9689
Practice Address - Street 1:8170 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:PA
Practice Address - Zip Code:19507-0032
Practice Address - Country:US
Practice Address - Phone:717-933-8934
Practice Address - Fax:717-933-9689
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHEL COMMUNITY AMBULANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-04
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05062341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014195000002Medicaid
PA280730Medicare PIN