Provider Demographics
NPI:1588870992
Name:GOODWILL HOSE COMPANY AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:GOODWILL HOSE COMPANY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-748-9022
Mailing Address - Street 1:512 CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:17745-3714
Mailing Address - Country:US
Mailing Address - Phone:570-748-9022
Mailing Address - Fax:570-748-0174
Practice Address - Street 1:512 CANAL STREET
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:PA
Practice Address - Zip Code:17745-3714
Practice Address - Country:US
Practice Address - Phone:570-748-9022
Practice Address - Fax:570-748-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0331663416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007464380001Medicaid
PA285103Medicare ID - Type UnspecifiedPA MEDICARE