Provider Demographics
NPI:1518951755
Name:GILBERTSVILLE AREA COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:GILBERTSVILLE AREA COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOLTONUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-367-9191
Mailing Address - Street 1:91 JACKSON RD
Mailing Address - Street 2:PO BOX 332
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9529
Mailing Address - Country:US
Mailing Address - Phone:610-367-9191
Mailing Address - Fax:610-369-3931
Practice Address - Street 1:91 JACKSON RD
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9529
Practice Address - Country:US
Practice Address - Phone:610-367-9191
Practice Address - Fax:610-369-3931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
14619OtherHEALTH PARTNERS
PA000987979000Medicaid
14619OtherHEALTH PARTNERS