Basic Information
| Provider Information | |||||||||
| NPI: | 1306825765 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BEAR CREEK BUCK TOWNSHIP AMBULANCE 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: | 3335 BEAR CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | BEAR CREEK TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187029760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708257111 | ||||||||
| FaxNumber: | 5708257111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCGOWAN | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 5708257111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 40047 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0014856030003 | 05 | PA | MEDICAID | 080161 | 01 | FIRST PRIORITY HEALTH | OTHER | 200371 | 01 | BC BS OF PA BLUE SHIELD | OTHER | 232402644 | 01 | BC OF NE PA | OTHER | 232402644 | 01 | PA TURNPIKE COMMISION | OTHER | 833809 | 01 | UMWA HEALTH RETIREMENT | OTHER | 0021908 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 590011745 | 01 | UNITED HC RR MEDICARE | OTHER | 232402644 | 01 | HEALTHMATE HMO DPA | OTHER |