Provider Demographics
NPI:1881753531
Name:HUNLOCK CREEK VOL AMBULANCE ASSOC
Entity type:Organization
Organization Name:HUNLOCK CREEK VOL AMBULANCE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-542-7958
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-0846
Mailing Address - Country:US
Mailing Address - Phone:570-714-3694
Mailing Address - Fax:
Practice Address - Street 1:1114 MAIN RD
Practice Address - Street 2:
Practice Address - City:HUNLOCK CREEK
Practice Address - State:PA
Practice Address - Zip Code:18621-3608
Practice Address - Country:US
Practice Address - Phone:570-542-7958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042073416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008827800002Medicaid
590014912OtherRAILROAD MEDICARE
800366OtherFEDERAL BLACK LUNG
PA0008827800002Medicaid