Provider Demographics
NPI:1497741466
Name:SHIPPENVILLE ELK TOWNSHIP VOLUNT
Entity Type:Organization
Organization Name:SHIPPENVILLE ELK TOWNSHIP VOLUNT
Other - Org Name:SHIPPENVILLE/ELK VOLUNTEER AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANNERAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-782-6245
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:800-473-2278
Mailing Address - Fax:
Practice Address - Street 1:207 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-3905
Practice Address - Country:US
Practice Address - Phone:814-782-6245
Practice Address - Fax:814-782-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030213416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012691900004Medicaid
282131OtherBCBS OF PA BLUE SHIELD
590010198OtherUNITED HC RR MEDICARE
000000OtherNY DPA COMPUTER SCIENCES
000000OtherNY EMPIRE MEDICARE
081243600OtherFEDERAL BLACK LUNG
000000OtherNY DPA COMPUTER SCIENCES