Basic Information
| Provider Information | |||||||||
| NPI: | 1134115207 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CITY OF WARREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004732278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 314 W 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | WARREN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 163652334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147232950 | ||||||||
| FaxNumber: | 8147233242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | PASCUZZI | ||||||||
| AuthorizedOfficialFirstName: | SANTO | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | FIRE CHIEF CITY OF WARRREN | ||||||||
| AuthorizedOfficialTelephone: | 8147232950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0014089360003 | 05 | PA | MEDICAID | 1043236 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 50040817 | 01 | CAPITAL BLUE CROSS BASIC | OTHER | 223998 | 01 | PA | BC BS OF PA BLUE SHIELD | OTHER | 833811 | 01 | UMWA HEALTH & RETIREMENT | OTHER |