Provider Demographics
NPI:1891854840
Name:NANTICOKE COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:NANTICOKE COMMUNITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORIEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-735-5201
Mailing Address - Street 1:901 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-3107
Mailing Address - Country:US
Mailing Address - Phone:570-735-5201
Mailing Address - Fax:
Practice Address - Street 1:901 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-3107
Practice Address - Country:US
Practice Address - Phone:570-735-5201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077655OtherFIRST PRIORITY HEALTH
PA0012655480006Medicaid
899989OtherFEDERAL BLACK LUNG
590010467Medicare PIN
PA280439Medicare PIN