Basic Information
| Provider Information | |||||||||
| NPI: | 1881680957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORBISONIA ROCKHILL FIRE CO AMB | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004732278 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 ELLIOTT ST | ||||||||
| Address2: | |||||||||
| City: | ORBISONIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144473221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCLAIN | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | TRUSTEE / RESCUE CAPT | ||||||||
| AuthorizedOfficialTelephone: | 8144473221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | 04287 | PA | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 283430 | 01 | PA | BCBS OF PA | OTHER | 0030369 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 0008575170004 | 05 | PA | MEDICAID | 833832 | 01 | UMWA HEALTH & RET. FUNDS | OTHER | 1131860 | 01 | KEYSTONE MERCY HMO DPA | OTHER |