Basic Information
| Provider Information | |||||||||
| NPI: | 1912995747 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MOUNTAINTP COMMUNITY AMBULANCE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | MOUNTAINTOP AREA COMMUNITY AMBULANCE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
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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: | RTE 437-309 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN TOP | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704742513 | ||||||||
| FaxNumber: | 5704742513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HERRON | ||||||||
| AuthorizedOfficialFirstName: | JEAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5704749751 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 0X00PA0847 | 01 | QUALMED | OTHER | 0597142 | 01 | AETNA USHC BLUE BELL HMO | OTHER | 0X00PA0847 | 01 | ACS HEALTHNET HMO MDC | OTHER | 0X00PA0847 | 01 | PHS HEALTH PLAN COMMERCIA | OTHER | 0014802690003 | 05 | PA | MEDICAID | 0X00PA0847 | 01 | PHS HEALTH PLAN HMO MDC | OTHER | 590008832 | 01 | UNITED HC RR MEDICARE | OTHER | 0X00PA0847 | 01 | ACS HEALTHNET COMMERCIAL | OTHER | 1587077 | 01 | BCBS OF NE PA ACESS CARE | OTHER | 225955 | 01 | BC BS OF PA BLUE SHIELD | OTHER | 077070 | 01 | FIRST PRIORITY HEALTH | OTHER |