Provider Demographics
NPI:1841299872
Name:MONT ALTO AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:MONT ALTO AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-749-5552
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:MONT ALTO
Mailing Address - State:PA
Mailing Address - Zip Code:17237-0327
Mailing Address - Country:US
Mailing Address - Phone:717-749-5558
Mailing Address - Fax:717-749-5999
Practice Address - Street 1:603 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONT ALTO
Practice Address - State:PA
Practice Address - Zip Code:17237-0327
Practice Address - Country:US
Practice Address - Phone:717-749-5558
Practice Address - Fax:717-749-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68743OtherGEISINGER HEALTH PLAN
PA36403OtherHEALTH PARTNERS
PA0035984000OtherINDEPENDENCE BLUE CROSS
PA280197OtherHIGHMARK BLUE SHIELD
GA39EA32OtherCAPITAL BLUE CROSS
PA95794OtherHEALTH ASSURANCE
PA0035984000OtherAMERIHEALTH
MD407517000Medicaid
GA832915182AMedicaid
PA0016719680001Medicaid
PA2462831OtherAETNA
PA200055Medicare PIN
PA280197OtherHIGHMARK BLUE SHIELD