Provider Demographics
NPI:1427129428
Name:BLANDON COMMUNITY AMBULANCE ASSN INC.
Entity type:Organization
Organization Name:BLANDON COMMUNITY AMBULANCE ASSN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-926-7297
Mailing Address - Street 1:P.O. BOX 258
Mailing Address - Street 2:28 W WESNER ROAD
Mailing Address - City:BLANDON
Mailing Address - State:PA
Mailing Address - Zip Code:19510-9702
Mailing Address - Country:US
Mailing Address - Phone:610-926-7797
Mailing Address - Fax:610-926-6048
Practice Address - Street 1:28 W WESNER RD
Practice Address - Street 2:
Practice Address - City:BLANDON
Practice Address - State:PA
Practice Address - Zip Code:19510-9702
Practice Address - Country:US
Practice Address - Phone:610-926-7797
Practice Address - Fax:610-926-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021893416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA285122Medicare PIN