Provider Demographics
NPI:1770654774
Name:NORTHERN LEHIGH AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:NORTHERN LEHIGH AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B, CAC
Authorized Official - Phone:610-769-7920
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:SLATINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18080-0148
Mailing Address - Country:US
Mailing Address - Phone:610-769-7920
Mailing Address - Fax:610-769-7887
Practice Address - Street 1:4525 SPRING HILL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SCHNECKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18078-2546
Practice Address - Country:US
Practice Address - Phone:610-769-7920
Practice Address - Fax:610-769-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042693416L0300X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012472840001Medicaid
PA1012472840001Medicaid