Basic Information
| Provider Information | |||||||||
| NPI: | 1235346552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OLD FORGE AMBULANCE & RESCUE ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846642007 | ||||||||
| FaxNumber: | 4846642015 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 RAILROAD ST | ||||||||
| Address2: | |||||||||
| City: | OLD FORGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185182003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704579693 | ||||||||
| FaxNumber: | 5705048343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 12/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | GOTAY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 5704579693 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 05134 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 590007073 | 01 | PA | RAILROAD MEDICARE | OTHER | 0012373830004 | 05 | PA | MEDICAID | 801316 | 01 | PA | FEDERAL BLACK LUNG | OTHER |