Provider Demographics
NPI:1255504486
Name:GRAND VIEW MEDICAL COMPANY
Entity Type:Organization
Organization Name:GRAND VIEW MEDICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WUERSTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-453-4604
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18960
Mailing Address - Country:US
Mailing Address - Phone:215-453-4700
Mailing Address - Fax:215-453-4758
Practice Address - Street 1:700 LAWN AVE
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1548
Practice Address - Country:US
Practice Address - Phone:215-453-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03295341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007276130001Medicaid
PA1032369OtherAMERIHEALTH MERCY ID
PA0000115000OtherKEYSTONE HEALTH PLAN EAST
PA1032369OtherKEYSTONE MERCY ID
PA5499634OtherAETNA PROV ID EL PASO
PA1032369OtherKEYSTONE MERCY ID