Provider Demographics
NPI:1578559555
Name:KULPMONT COMMUNITY AMB ASSOC
Entity Type:Organization
Organization Name:KULPMONT COMMUNITY AMB ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:OHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-373-1103
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:484-664-2017
Practice Address - Street 1:12 N 8TH ST
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1343
Practice Address - Country:US
Practice Address - Phone:570-373-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
811890OtherFIRST PRIORITY HEALTH
0012017920004OtherPA MEDICAID
0820315OtherAETNA USHC BLUE BELL HMO
214022OtherBC BS OF PA BLUE SHIELD
804534OtherUMWA HEALTH & RETIREMENT
0820315OtherAETNA USHC BLUE BELL HMO