Provider Demographics
NPI:1275663163
Name:BALLY COMMUNITY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:BALLY COMMUNITY AMBULANCE ASSOCIATION
Other - Org Name:BALLY COMMUNITY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:EDDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-845-2501
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:BALLY
Mailing Address - State:PA
Mailing Address - Zip Code:19503-0353
Mailing Address - Country:US
Mailing Address - Phone:610-845-2501
Mailing Address - Fax:610-845-7898
Practice Address - Street 1:537 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BALLY
Practice Address - State:PA
Practice Address - Zip Code:19503-9615
Practice Address - Country:US
Practice Address - Phone:610-845-2501
Practice Address - Fax:610-845-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011886090001Medicaid
PA286825Medicare PIN