Provider Demographics
NPI:1790850972
Name:JENKINS TOWNSHIP AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:JENKINS TOWNSHIP AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:570-714-3694
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-0846
Mailing Address - Country:US
Mailing Address - Phone:570-714-3694
Mailing Address - Fax:
Practice Address - Street 1:2 2ND ST
Practice Address - Street 2:
Practice Address - City:PORT GRIFFITH
Practice Address - State:PA
Practice Address - Zip Code:18640-1511
Practice Address - Country:US
Practice Address - Phone:570-655-3603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011173110003Medicaid
807008OtherFEDERAL BLACK LUNG
PA200503Medicare ID - Type Unspecified