Basic Information
| Provider Information | |||||||||
| NPI: | 1528054699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HANOVER TOWNSHIP COMMUNITY AMBULANCE ASSOCIATION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004732278 | ||||||||
| FaxNumber: | 4846642015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | HANOVER TOWNSHIP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187065034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708251266 | ||||||||
| FaxNumber: | 5709709830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 11/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | RINKEVICH | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | FINANCIAL SEC | ||||||||
| AuthorizedOfficialTelephone: | 5708224213 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | SR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 04188 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 208815 | 01 | PA | BC BS OF PA BLUE SHIELD | OTHER | PA0497 | 01 | QUALMED | OTHER | 0585780 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 811093 | 01 | UMWA HEALTH & RETIREMENT | OTHER | P032492 | 01 | TRI CARE MID ATL | OTHER | PA0497 | 01 | ACS HEALTH NET HMO MDC | OTHER | 0014373480003 | 05 | PA | MEDICAID | P032492 | 01 | TRI CARE NORTHEAST | OTHER | PA0497 | 01 | PHS HEALTH PLAN HMO MDC | OTHER | 081109300 | 01 | FEDERAL BLACK LUNG | OTHER | PA0497 | 01 | ACS HEALTH NET COMMERCIAL | OTHER | 077535 | 01 | FIRST PRIORITY HEALTH | OTHER | PA0497 | 01 | PHS HEALTH PLAN COMMERCIA | OTHER |