Provider Demographics
NPI:1316097462
Name:PLYMOUTH BOROUGH AMBULANCE ASSOC. INC.
Entity type:Organization
Organization Name:PLYMOUTH BOROUGH AMBULANCE ASSOC. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-779-4388
Mailing Address - Street 1:24 GAYLORD AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:PA
Mailing Address - Zip Code:18651-2202
Mailing Address - Country:US
Mailing Address - Phone:570-779-9878
Mailing Address - Fax:570-779-4666
Practice Address - Street 1:24 GAYLORD AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:PA
Practice Address - Zip Code:18651-2202
Practice Address - Country:US
Practice Address - Phone:570-779-9878
Practice Address - Fax:570-779-4666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04175341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2165244OtherAETNA USHC BLUE BELL HMO
PA590014556OtherUNITED HC RR MEDICARE
PA0019186260001Medicaid
PA808300OtherFIRST PRIORITY HEALTH
PA080026400OtherFEDERAL BLACK LUNG
PAPA7879OtherPHS HEALTH PLAN COMMERCIA
PA201756OtherBC BS OF PA BLUE SHIELD
PAPA7879OtherACS HEALTH NET HMO MDC
PAPA7879OtherPHS HEALTH PLAN HMO MDC
PAPA7879OtherQUALMED
PA30013904OtherKEYSTONE MERCY HMO DPA
PAPA7879OtherACS HEALTH NET COMMERCIAL
PAPA7879OtherQUALMED
PA201756OtherBC BS OF PA BLUE SHIELD
PA30013904OtherKEYSTONE MERCY HMO DPA