Provider Demographics
NPI:1083636526
Name:NESCOPECK COMMUNITY AMBULANCE ASSOC
Entity type:Organization
Organization Name:NESCOPECK COMMUNITY AMBULANCE ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIS
Authorized Official - Middle Name:H
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-759-0391
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:
Mailing Address - City:NESCOPECK
Mailing Address - State:PA
Mailing Address - Zip Code:18635-0526
Mailing Address - Country:US
Mailing Address - Phone:570-759-0391
Mailing Address - Fax:
Practice Address - Street 1:99 WARREN ST.
Practice Address - Street 2:
Practice Address - City:NESCOPECK
Practice Address - State:PA
Practice Address - Zip Code:18635
Practice Address - Country:US
Practice Address - Phone:570-759-0391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008502300001Medicaid
PA93285OtherHEALTH AMERICA
PA280932Medicare PIN
PA0008502300001Medicaid