Provider Demographics
NPI:1720108616
Name:SWEET VALLEY AMBULANCE ASSOCIATION, INC
Entity Type:Organization
Organization Name:SWEET VALLEY AMBULANCE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-477-5239
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:SWEET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18656-0207
Mailing Address - Country:US
Mailing Address - Phone:570-477-5500
Mailing Address - Fax:
Practice Address - Street 1:5399 MAIN RD
Practice Address - Street 2:
Practice Address - City:SWEET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18656-2485
Practice Address - Country:US
Practice Address - Phone:570-477-5500
Practice Address - Fax:570-477-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051043416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012930880001Medicaid
PA287520Medicare ID - Type UnspecifiedMEDICARE