Provider Demographics
NPI:1861497893
Name:KATHLEEN M MINNICH
Entity Type:Organization
Organization Name:KATHLEEN M MINNICH
Other - Org Name:CENTRAL MEDICAL AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINNICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-1070
Mailing Address - Street 1:3632 HILL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17046-9350
Mailing Address - Country:US
Mailing Address - Phone:717-270-1070
Mailing Address - Fax:717-273-8373
Practice Address - Street 1:201 E PENN AVE
Practice Address - Street 2:
Practice Address - City:CLEONA
Practice Address - State:PA
Practice Address - Zip Code:17042-2429
Practice Address - Country:US
Practice Address - Phone:717-270-1070
Practice Address - Fax:717-273-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA301298OtherHEALTH ASSURANCE
PA301298OtherHEALTH AMERICA
PA20007524OtherAMERIHEALTH
PA1511694OtherGATEWAY HEALTH
PA0012164090004Medicaid
PA301298OtherHEALTH AMERICA