Provider Demographics
NPI:1093734212
Name:HAZLETON COMMUNITY AMBULANCE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:HAZLETON COMMUNITY AMBULANCE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:G
Authorized Official - Last Name:WHITENIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-455-5902
Mailing Address - Street 1:465 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-6711
Mailing Address - Country:US
Mailing Address - Phone:570-455-5902
Mailing Address - Fax:
Practice Address - Street 1:465 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6711
Practice Address - Country:US
Practice Address - Phone:570-455-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA998531OtherBLUE CROSS NEPA
PA281189OtherHIGHMARK BS
PA153651XXOtherPREFERRED CARE
PA0011580100001Medicaid
PA281189Medicare ID - Type Unspecified