Provider Demographics
NPI:1801950662
Name:BARRETT TOWNSHIP AMBULANCE CORPS, INC
Entity type:Organization
Organization Name:BARRETT TOWNSHIP AMBULANCE CORPS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-595-7621
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326-0105
Mailing Address - Country:US
Mailing Address - Phone:570-595-7621
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 191
Practice Address - Street 2:
Practice Address - City:MOUNTAINHOME
Practice Address - State:PA
Practice Address - Zip Code:18324
Practice Address - Country:US
Practice Address - Phone:570-595-7621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA335965OtherHEALTH AMERICA
PA0007002140001Medicaid
PA998526OtherBLUE CROSS NEPA
PA998526OtherBLUE CROSS NEPA