Provider Demographics
NPI:1912043944
Name:ELVERSON - HONEY BROOK AREA EMS
Entity Type:Organization
Organization Name:ELVERSON - HONEY BROOK AREA EMS
Other - Org Name:ELVERSON EMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-286-8925
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520-0154
Mailing Address - Country:US
Mailing Address - Phone:610-286-8925
Mailing Address - Fax:610-913-6154
Practice Address - Street 1:4458 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELVERSON
Practice Address - State:PA
Practice Address - Zip Code:19520-9332
Practice Address - Country:US
Practice Address - Phone:610-286-8925
Practice Address - Fax:610-913-6154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012916460001Medicaid
PA107553Medicare PIN