Provider Demographics
NPI:1679569735
Name:BIG VALLEY AMBULANCE CLUB, INC.
Entity Type:Organization
Organization Name:BIG VALLEY AMBULANCE CLUB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BYLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:717-935-2290
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:800-473-2273
Mailing Address - Fax:
Practice Address - Street 1:4371 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-9256
Practice Address - Country:US
Practice Address - Phone:717-935-2317
Practice Address - Fax:717-935-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032183416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0289335OtherKEYSTONE HP CTRL HMO MDC
46137OtherGHP
0289335OtherKEYSTONE HP CTRL COMM.
2346118OtherAETNA USHC BLUE BELL HMO
PA0017718560001Medicaid
590007653OtherUNITED HC RR MEDICARE
PA289335OtherBCBS OF PA
=========OtherTRI CARE MID ATL
PA0017718560001Medicaid
590007653OtherUNITED HC RR MEDICARE