Provider Demographics
NPI:1720063860
Name:NORTHERN VALLEY EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:NORTHERN VALLEY EMERGENCY MEDICAL SERVICES INC
Other - Org Name:NORTHERN VALLEY EMS OR NOVA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRENEISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-262-1075
Mailing Address - Street 1:2375 LEVANS RD
Mailing Address - Street 2:
Mailing Address - City:COPLAY
Mailing Address - State:PA
Mailing Address - Zip Code:18037-2202
Mailing Address - Country:US
Mailing Address - Phone:610-262-1075
Mailing Address - Fax:610-262-8630
Practice Address - Street 1:2375 LEVANS RD
Practice Address - Street 2:
Practice Address - City:COPLAY
Practice Address - State:PA
Practice Address - Zip Code:18037-2202
Practice Address - Country:US
Practice Address - Phone:610-262-1075
Practice Address - Fax:610-262-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1505976OtherGATEWAY HEALTH PLAN
PA0017025720001Medicaid
PA1067558OtherAMERIHEALTH CARITAS/NORTHEAST
PA1067558OtherAMERIHEALTH CARITAS/NORTHEAST
PA0017025720001Medicaid