Provider Demographics
NPI:1821176892
Name:CHARLES J. SPELLMAN AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:CHARLES J. SPELLMAN AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOMER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-822-5587
Mailing Address - Street 1:14 MARION ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1419
Mailing Address - Country:US
Mailing Address - Phone:570-822-5587
Mailing Address - Fax:570-287-3384
Practice Address - Street 1:14 MARION ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1419
Practice Address - Country:US
Practice Address - Phone:570-822-5587
Practice Address - Fax:570-287-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04051341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA200510OtherBLUE CROSS/BLUE SHIELD
PA805657OtherFIRST PRIORITY
PACJ200510OtherMEDICARE TRAVELERS
PA0014501800001Medicaid
PA30230362SOtherGEISINGER HEALTH PLAN
PACJ200510OtherSTERLING
PA080008300OtherBLACK LUNG
PA568281OtherAETNA
PA84067OtherTHREE RIVERS
PA998506OtherBLUE CROSS NEPA
PACJ200510OtherFEDERAL BC/BS
PA20005603OtherAMERIHEALTH
PA200510OtherHIGHMARK
PA080008300OtherBLACK LUNG