Provider Demographics
NPI:1942236344
Name:A VITAL RESPONSE INC.
Entity Type:Organization
Organization Name:A VITAL RESPONSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-207-7780
Mailing Address - Street 1:1205 S 28TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-1046
Mailing Address - Country:US
Mailing Address - Phone:717-207-7780
Mailing Address - Fax:717-754-0011
Practice Address - Street 1:1205 S 28TH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1046
Practice Address - Country:US
Practice Address - Phone:717-207-7780
Practice Address - Fax:717-754-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060063416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001860315OtherHIGHMARK BLUE SHIELD PA
PA101535548Medicaid
PA0009029000OtherINDEPENDANCE BLUE CROSS
PA101535548Medicaid
PA001860315OtherHIGHMARK BLUE SHIELD PA
PA099205Medicare PIN