Provider Demographics
NPI:1689640591
Name:BOBTOWN DUNKARD TWP VOL FIRE DEPT AMBULANCE
Entity Type:Organization
Organization Name:BOBTOWN DUNKARD TWP VOL FIRE DEPT AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-325-4003
Mailing Address - Street 1:4158 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1933
Mailing Address - Country:US
Mailing Address - Phone:724-325-4003
Mailing Address - Fax:724-325-1603
Practice Address - Street 1:1 LARIMER AVENUE
Practice Address - Street 2:
Practice Address - City:BOBTOWN
Practice Address - State:PA
Practice Address - Zip Code:15315
Practice Address - Country:US
Practice Address - Phone:724-325-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010762820004Medicaid
PA208804Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA208804Medicare PIN