Provider Demographics
NPI:1114942992
Name:EAGLES MERE VOLUNTEER AMBULANCE
Entity Type:Organization
Organization Name:EAGLES MERE VOLUNTEER AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-525-3422
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:EAGLES MERE
Mailing Address - State:PA
Mailing Address - Zip Code:17731-0374
Mailing Address - Country:US
Mailing Address - Phone:570-525-3422
Mailing Address - Fax:
Practice Address - Street 1:49 FERN LN
Practice Address - Street 2:
Practice Address - City:EAGLES MERE
Practice Address - State:PA
Practice Address - Zip Code:17731
Practice Address - Country:US
Practice Address - Phone:570-525-3422
Practice Address - Fax:570-265-4797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012599070003Medicaid
PA0012599070003Medicaid