Provider Demographics
NPI:1184601742
Name:MOSHANNON VALLEY EMS
Entity type:Organization
Organization Name:MOSHANNON VALLEY EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-342-3292
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16866-0289
Mailing Address - Country:US
Mailing Address - Phone:814-342-3292
Mailing Address - Fax:814-342-1308
Practice Address - Street 1:14 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-2100
Practice Address - Country:US
Practice Address - Phone:814-342-3292
Practice Address - Fax:814-342-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03187341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1275334OtherUNITED MINE WORKERS
PA804703OtherFEDERAL BLACK LUNG (FBLP)
PA0014783400003Medicaid
PA212641OtherBLUE CROSS BLUE SHIELD
PA50002939OtherCAPITAL BLUE CROSS
PA00035215OtherSTATE WORKMEN'S INS. FUND
PAPO20236OtherCHAMPUS
PA1275334OtherUNITED MINE WORKERS
PA804703OtherFEDERAL BLACK LUNG (FBLP)