Provider Demographics
NPI:1851523138
Name:BLOOMSBURG VOLUNTEER AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:BLOOMSBURG VOLUNTEER AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-784-6237
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1870
Mailing Address - Country:US
Mailing Address - Phone:570-784-6237
Mailing Address - Fax:
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1870
Practice Address - Country:US
Practice Address - Phone:570-784-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023714680001Medicaid
PA1023714680001Medicaid
PA161137Medicare PIN