Provider Demographics
NPI:1639167448
Name:WESTERN BERKS AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:WESTERN BERKS AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-678-1545
Mailing Address - Street 1:2506 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1535
Mailing Address - Country:US
Mailing Address - Phone:610-678-1545
Mailing Address - Fax:610-670-3783
Practice Address - Street 1:2506 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1535
Practice Address - Country:US
Practice Address - Phone:610-678-1545
Practice Address - Fax:610-670-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03096146L00000X
341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes341600000XTransportation ServicesAmbulance
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000991677Medicaid
PA282100Medicare ID - Type Unspecified