Provider Demographics
NPI:1760581292
Name:PALMERTON COMMUNITY AMBULANCE ASSOCIATION, INC.
Entity Type:Organization
Organization Name:PALMERTON COMMUNITY AMBULANCE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER/BOARD OF DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-401-1279
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:501 DELAWARE AVENUE
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071
Mailing Address - Country:US
Mailing Address - Phone:610-826-7809
Mailing Address - Fax:610-826-5327
Practice Address - Street 1:501 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-0002
Practice Address - Country:US
Practice Address - Phone:610-826-7609
Practice Address - Fax:610-826-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA061113416L0300X
PA06111PA3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0145827OtherBC OF TENN
PA0780734/01OtherMED PLUS
NY1528003OtherGATEWAY
PA50002800OtherCAP. BC
PA127702OtherUNISON MED PLUS
PA20012758OtherAMERIHEALTH MERCY
PA284951OtherHIGHMARK BS
PA74817OtherATHEM BLUE
PA0025427000OtherPERSONAL CHOICE
PA590007582OtherRR MED
PA0007807340001Medicaid
31245OtherHEALTH PARTNERS
PA1154979OtherKEYSTONE MERCY
PA808539OtherFIRST PRIOITY
PA002542700OtherAMERIHEALTH
2709438OtherOXFORD
2709438OtherOXFORD
PARR2001Medicare ID - Type UnspecifiedMEDICARE RAILROAD