Provider Demographics
NPI:1205837267
Name:POTTSVILLE AREA EMERGENCY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:POTTSVILLE AREA EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LAUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-9647
Mailing Address - Street 1:320 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2346
Mailing Address - Country:US
Mailing Address - Phone:570-622-9647
Mailing Address - Fax:570-622-9648
Practice Address - Street 1:320 N 9TH ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2346
Practice Address - Country:US
Practice Address - Phone:570-622-9647
Practice Address - Fax:570-622-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080249800OtherFEDERAL BLACK LUNG PROGRAM
PA34971OtherHEALTH PARTNERS
PA1503196OtherGATEWAY HEALTH PLAN
PA216669OtherHIGHMARK BLUE SHIELD
PA50004344OtherCAPITAL BLUE CROSS
PA0013964500005Medicaid
PAP023290OtherTRICARE
AR20010626OtherAMERIHEALTH CARITAS
PA30009167OtherKEYSTONE MERCY HEALTH PLAN
PA080249800OtherUS DEPARTMENT OF LABOR
PA653509OtherVICTIM'S COMPENSATION
PA216669Medicare PIN
PA50004344OtherCAPITAL BLUE CROSS