Provider Demographics
NPI:1801883228
Name:MAHONING VALLEY AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:MAHONING VALLEY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:570-386-5800
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:800-473-2278
Mailing Address - Fax:484-664-2015
Practice Address - Street 1:902 MILL RD
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9667
Practice Address - Country:US
Practice Address - Phone:570-386-2518
Practice Address - Fax:570-386-3268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0930709OtherAETNA USHC BLUE BELL HMO
281283OtherBC BS OF PA BLUE SHIELD
812110OtherFIRST PRIORITY HEALTH
PA0012008100001Medicaid
281283OtherSIGNATURE 65 2NDRY ONLY
281283OtherCLASSIC BLUE MAJMED ZAH Z
281283OtherDIRECT BLUE ZAB
281283OtherPPO BLUE ZAR
281283OtherMEDIGAP BLUE 2NDRY ONLY
281283OtherSELECT BLUE HMO
281283OtherCLASSIC BLUE ZAH
281283OtherFEDERAL BC BS
281283OtherSPECIAL CARE SOC MISS BC
441590544OtherUNITED HC RR MEDICARE
1144160OtherKEYSTON MERCY HMO DPA
833808OtherUMWA HEALTH & RETIREMENT
812110OtherFIRST PRIORITY HEALTH
=========OtherKEYSTON HP EAST HMO MDC
PA281283Medicare PIN