Provider Demographics
NPI:1386607539
Name:WILLIAMSBURG AMBULANCE CLUB
Entity type:Organization
Organization Name:WILLIAMSBURG AMBULANCE CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-695-1421
Mailing Address - Street 1:801 SCOTCH VALLEY ROAD
Mailing Address - Street 2:PO BOX 461
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0461
Mailing Address - Country:US
Mailing Address - Phone:814-695-1421
Mailing Address - Fax:814-695-8280
Practice Address - Street 1:418 W SECOND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693
Practice Address - Country:US
Practice Address - Phone:814-695-1421
Practice Address - Fax:814-695-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031493416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
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137552OtherHEALTHASSURANCE
PA0016844100001Medicaid
000000090886OtherUNISON HEALTH PLAN
PA1504722OtherGATEWAY
46185OtherGEISINGER HEALTH PLAN
302140OtherUPMC FOR YOU