Basic Information
| Provider Information | |||||||||
| NPI: | 1861481269 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POCONO MOUNTAIN REGIONAL EMERGENCY MEDICAL SERVICES, INC | ||||||||
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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: | 135 TEGAWITHA RD | ||||||||
| Address2: | |||||||||
| City: | TOBYHANNA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 184667796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708398485 | ||||||||
| FaxNumber: | 5708390777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 02/05/2016 | ||||||||
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| AuthorizedOfficialLastName: | DOREMUS | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5703500029 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 1446752 | 01 | BC OF NE PA | OTHER | 359501200 | 01 | DEPT OF LABOR WORK COMP | OTHER | 816393 | 01 | FIRST PRIORITY HEALTH | OTHER | 001945900003 | 05 | PA | MEDICAID | 20035568 | 01 | AMERIHEALTH MERCY HMO DPA | OTHER | 0019454900001 | 05 | PA | MEDICAID | 816393 | 01 | BCNE CONTRACT CLAIMS | OTHER |