Provider Demographics
NPI:1821122235
Name:LOWER ALSACE VOLUNTEER AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:LOWER ALSACE VOLUNTEER AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-779-0190
Mailing Address - Street 1:750 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1400
Mailing Address - Country:US
Mailing Address - Phone:610-779-0190
Mailing Address - Fax:610-779-9143
Practice Address - Street 1:750 N 25TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-1400
Practice Address - Country:US
Practice Address - Phone:610-779-0190
Practice Address - Fax:610-779-9143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060983416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011361200005Medicaid
PA0093888000OtherINDEPENDENCE BLUE CROSS
PA50006179OtherCAPITAL BLUE CROSS
PA590010476OtherPALMETTO GBA MEDICARE RAI
PA209088OtherHIGH MARK BLUE SHIELD
PA0093888000OtherINDEPENDENCE BLUE CROSS