Provider Demographics
NPI:1619052792
Name:PENNDEL-MIDDLETOWN EMERGENCY SQUAD
Entity Type:Organization
Organization Name:PENNDEL-MIDDLETOWN EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-757-2663
Mailing Address - Street 1:616 E LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2905
Mailing Address - Country:US
Mailing Address - Phone:215-757-2663
Mailing Address - Fax:215-757-0222
Practice Address - Street 1:616 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2905
Practice Address - Country:US
Practice Address - Phone:215-757-2663
Practice Address - Fax:215-757-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KEYSTONE HEALTH PLANOther0023627000
PAX000330701OtherAMERICHOICE
PA47585OtherKEYSTONE MERCY
0006325OtherAETNA
PA0023627000OtherPERSONAL CHOICE
PA07935OtherSENIOR PARTNERS
PA0008923290001Medicaid
PA07935OtherHEALTH PARTNERS
PA0008923290001Medicaid
PA0023627000OtherPERSONAL CHOICE
PA07935OtherHEALTH PARTNERS