Provider Demographics
NPI:1912995747
Name:MOUNTAINTP COMMUNITY AMBULANCE
Entity Type:Organization
Organization Name:MOUNTAINTP COMMUNITY AMBULANCE
Other - Org Name:MOUNTAINTOP AREA COMMUNITY AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-474-9751
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:484-664-2007
Mailing Address - Fax:484-664-2015
Practice Address - Street 1:RTE 437-309
Practice Address - Street 2:
Practice Address - City:MOUNTAIN TOP
Practice Address - State:PA
Practice Address - Zip Code:18707
Practice Address - Country:US
Practice Address - Phone:570-474-2513
Practice Address - Fax:570-474-2513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
0X00PA0847OtherQUALMED
0597142OtherAETNA USHC BLUE BELL HMO
0X00PA0847OtherACS HEALTHNET HMO MDC
0X00PA0847OtherPHS HEALTH PLAN COMMERCIA
PA0014802690003Medicaid
0X00PA0847OtherPHS HEALTH PLAN HMO MDC
590008832OtherUNITED HC RR MEDICARE
0X00PA0847OtherACS HEALTHNET COMMERCIAL
1587077OtherBCBS OF NE PA ACESS CARE
225955OtherBC BS OF PA BLUE SHIELD
077070OtherFIRST PRIORITY HEALTH
0X00PA0847OtherPHS HEALTH PLAN HMO MDC