Provider Demographics
NPI:1881643278
Name:MACUNGIE AMBULANCE CORP
Entity Type:Organization
Organization Name:MACUNGIE AMBULANCE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GREB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-966-2601
Mailing Address - Street 1:5550 N WALNUT ST
Mailing Address - Street 2:P.O.BOX 114
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1323
Mailing Address - Country:US
Mailing Address - Phone:610-966-2601
Mailing Address - Fax:610-966-1561
Practice Address - Street 1:5550 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1323
Practice Address - Country:US
Practice Address - Phone:610-966-2601
Practice Address - Fax:610-966-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03289341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011431600003Medicaid
PA209264Medicare ID - Type Unspecified