Basic Information
| Provider Information | |||||||||
| NPI: | 1669468732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LARKSVILLE COMMMUNITY AMBULANCE | ||||||||
| LastName: | |||||||||
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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: | 480 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | LARKSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 186511407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707794778 | ||||||||
| FaxNumber: | 5707794828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 04/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | STEVENSON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CAPTAIN | ||||||||
| AuthorizedOfficialTelephone: | 5707794828 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | EMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 03372 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0471301 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 080816 | 01 | FIRST PRIORITY HEALTH | OTHER | PB4425 | 01 | ACS HEALTH NET HMO MDC | OTHER | PB4425 | 01 | PHS HEALTH PLAN HMO MDC | OTHER | PB4425 | 01 | ACS HEALTH NET COMMERCIAL | OTHER | 0015286200003 | 01 | PA MEDICAID | OTHER | 222759 | 01 | BC BS OF PA BLUE SHIELD | OTHER | 811529 | 01 | UMWA HEALTH & RETIREMENT | OTHER | PB4425 | 01 | PHS HEALTH PLAN COMMERCIA | OTHER | PB4425 | 01 | QUALMED | OTHER |