Provider Demographics
NPI:1306996244
Name:WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:WYOMING VALLEY PROFESSIONAL AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALVIN
Authorized Official - Last Name:HONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-825-2317
Mailing Address - Street 1:PO BOX 2398
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18703-2398
Mailing Address - Country:US
Mailing Address - Phone:800-601-9881
Mailing Address - Fax:570-825-9795
Practice Address - Street 1:6 ROSE LN
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5952
Practice Address - Country:US
Practice Address - Phone:570-825-2317
Practice Address - Fax:570-829-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA40220341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2088016000OtherINDEPENDENCE BLUE CROSS
NY8191213OtherINDEPENDENT HEALTH
PA2088016000OtherAMERIHELATH INC
PA30012666OtherKEYSTON MERCY
PA00000137400OtherUNISON HEALTH PLAN OF PA
PA2088016000OtherAMERIHELATH INC