Provider Demographics
NPI:1770528788
Name:SHICKSHINNY AREA VOLUNTEER AMBULANCE ASSOC INC
Entity type:Organization
Organization Name:SHICKSHINNY AREA VOLUNTEER AMBULANCE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REMENSNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-542-7707
Mailing Address - Street 1:7 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOCANAQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18655-1505
Mailing Address - Country:US
Mailing Address - Phone:570-542-7707
Mailing Address - Fax:570-542-7858
Practice Address - Street 1:32 E UNION ST
Practice Address - Street 2:
Practice Address - City:SHICKSHINNY
Practice Address - State:PA
Practice Address - Zip Code:18655-1211
Practice Address - Country:US
Practice Address - Phone:570-542-7707
Practice Address - Fax:570-542-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA335969OtherHEALTH AMERICA/ASSURANCE
PA0011821690008Medicaid
PA335969OtherHEALTH AMERICA/ASSURANCE