Basic Information
| Provider Information | |||||||||
| NPI: | 1730175704 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NESQUEHONING AMBULANCE CORPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004732278 | ||||||||
| FaxNumber: | 4846642017 | ||||||||
| Practice Location | |||||||||
| Address1: | 953 E CATAWISSA ST | ||||||||
| Address2: | |||||||||
| City: | NESQUEHONING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182401810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706696684 | ||||||||
| FaxNumber: | 5706696718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCARDLE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5706696684 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 04113 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0883631 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 284275 | 01 | BCBS OF PA BLUE SHIELD | OTHER | 807166 | 01 | FIRST PRIORITY HEALTH | OTHER | 590011184 | 01 | UNITED HC RR MEDICARE | OTHER | 0014512760003 | 05 | PA | MEDICAID | 20037243 | 01 | AMERIHEALTH MERCY HMO DPA | OTHER |