Provider Demographics
NPI:1821163080
Name:EXETER COMMUNITY AMBULANCE ASSOC
Entity Type:Organization
Organization Name:EXETER COMMUNITY AMBULANCE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-237-1090
Mailing Address - Street 1:1091 WYOMING AVE.
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1915
Mailing Address - Country:US
Mailing Address - Phone:570-655-3771
Mailing Address - Fax:570-602-9907
Practice Address - Street 1:1091 WYOMING AVE.
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:PA
Practice Address - Zip Code:18643-1915
Practice Address - Country:US
Practice Address - Phone:570-655-3771
Practice Address - Fax:570-602-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
800371OtherFEDERAL BLACK LUNG
PA0015112110001Medicaid
PA0015112110001Medicaid