Provider Demographics
NPI:1669468732
Name:LARKSVILLE COMMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:LARKSVILLE COMMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-779-4828
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:484-664-2007
Mailing Address - Fax:484-664-2015
Practice Address - Street 1:480 E STATE ST
Practice Address - Street 2:
Practice Address - City:LARKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18651-1407
Practice Address - Country:US
Practice Address - Phone:570-779-4778
Practice Address - Fax:570-779-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033723416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0471301OtherAETNA USHC BLUE BELL HMO
080816OtherFIRST PRIORITY HEALTH
PB4425OtherACS HEALTH NET HMO MDC
PB4425OtherPHS HEALTH PLAN HMO MDC
PB4425OtherACS HEALTH NET COMMERCIAL
0015286200003OtherPA MEDICAID
222759OtherBC BS OF PA BLUE SHIELD
811529OtherUMWA HEALTH & RETIREMENT
PB4425OtherPHS HEALTH PLAN COMMERCIA
PB4425OtherQUALMED
PA122619Medicare PIN