Provider Demographics
NPI:1669678314
Name:KETTLE CREEK AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:KETTLE CREEK AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:DINGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-923-2111
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:CROSS FORK
Mailing Address - State:PA
Mailing Address - Zip Code:17729-0289
Mailing Address - Country:US
Mailing Address - Phone:570-923-2111
Mailing Address - Fax:570-923-9900
Practice Address - Street 1:7 FIREHOUSE LANE
Practice Address - Street 2:
Practice Address - City:CROSS FORK
Practice Address - State:PA
Practice Address - Zip Code:17729-0289
Practice Address - Country:US
Practice Address - Phone:570-923-2111
Practice Address - Fax:570-923-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021552940001Medicaid
PA200306Medicare PIN