Provider Demographics
NPI:1538305966
Name:NOXEN COMMUNITY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:NOXEN COMMUNITY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-298-0905
Mailing Address - Street 1:142 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:NOXEN
Mailing Address - State:PA
Mailing Address - Zip Code:18636-7723
Mailing Address - Country:US
Mailing Address - Phone:570-298-0905
Mailing Address - Fax:
Practice Address - Street 1:142 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:NOXEN
Practice Address - State:PA
Practice Address - Zip Code:18636-7723
Practice Address - Country:US
Practice Address - Phone:570-298-0905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022706800001Medicaid
PA1022706800001Medicaid