Provider Demographics
NPI:1497732721
Name:GREAT BEND HALLSTEAD VOLUNTEER AMBULANCE INC
Entity Type:Organization
Organization Name:GREAT BEND HALLSTEAD VOLUNTEER AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-879-2026
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:315-635-1789
Mailing Address - Fax:
Practice Address - Street 1:5 CARROL ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:PA
Practice Address - Zip Code:18821-7700
Practice Address - Country:US
Practice Address - Phone:570-879-4483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05007341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
590014168OtherPALMETTO GBA RAILROAD
PA00076001630003Medicaid
07600166OtherGATEWAY HEALTH PLAN
PA00076001630003Medicaid