Basic Information
| Provider Information | |||||||||
| NPI: | 1801883228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAHONING VALLEY AMBULANCE ASSOCIATION | ||||||||
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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: | 902 MILL RD | ||||||||
| Address2: | |||||||||
| City: | LEHIGHTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182359667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5703862518 | ||||||||
| FaxNumber: | 5703863268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | WALTER | ||||||||
| AuthorizedOfficialTitleorPosition: | TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 5703865800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 04213 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0930709 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 281283 | 01 | BC BS OF PA BLUE SHIELD | OTHER | 812110 | 01 | FIRST PRIORITY HEALTH | OTHER | 0012008100001 | 05 | PA | MEDICAID | 281283 | 01 | SIGNATURE 65 2NDRY ONLY | OTHER | 281283 | 01 | CLASSIC BLUE MAJMED ZAH Z | OTHER | 281283 | 01 | DIRECT BLUE ZAB | OTHER | 281283 | 01 | PPO BLUE ZAR | OTHER | 281283 | 01 | MEDIGAP BLUE 2NDRY ONLY | OTHER | 281283 | 01 | SELECT BLUE HMO | OTHER | 281283 | 01 | CLASSIC BLUE ZAH | OTHER | 281283 | 01 | FEDERAL BC BS | OTHER | 281283 | 01 | SPECIAL CARE SOC MISS BC | OTHER | 441590544 | 01 | UNITED HC RR MEDICARE | OTHER | 1144160 | 01 | KEYSTON MERCY HMO DPA | OTHER | 833808 | 01 | UMWA HEALTH & RETIREMENT | OTHER |