Provider Demographics
NPI:1093880262
Name:WEST PITTSTON COMMUNITY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:WEST PITTSTON COMMUNITY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRESTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-655-9122
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 1:401 TUNKHANNOCK AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-1223
Practice Address - Country:US
Practice Address - Phone:570-654-2747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042713416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
590011759OtherRAILROAD MEDICARE
800358OtherFEDERAL BLACK LUNG
PA0015399380003Medicaid
800358OtherFEDERAL BLACK LUNG