Provider Demographics
NPI:1609846492
Name:IRVONA VOLUNTEER AMBULANCE SERVICES
Entity Type:Organization
Organization Name:IRVONA VOLUNTEER AMBULANCE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE SUPERVISOR / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-672-3751
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:IRVONA
Mailing Address - State:PA
Mailing Address - Zip Code:16656-0151
Mailing Address - Country:US
Mailing Address - Phone:814-672-3751
Mailing Address - Fax:814-672-3751
Practice Address - Street 1:130 JULIA STREET
Practice Address - Street 2:
Practice Address - City:IRVONA
Practice Address - State:PA
Practice Address - Zip Code:16656-0151
Practice Address - Country:US
Practice Address - Phone:814-672-3751
Practice Address - Fax:814-672-3751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05088 PA DEPT OF HEA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0076602280002Medicaid
PA707131OtherUPMC
PA30514OtherGEISINGER
PA610409400OtherD O L
PA239396OtherHIGHMARK
PA30514OtherGEISINGER