Provider Demographics
NPI:1598815466
Name:WIND GAP AMBULANCE CORPS INC
Entity type:Organization
Organization Name:WIND GAP AMBULANCE CORPS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-863-7623
Mailing Address - Street 1:547 E WEST ST
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-1255
Mailing Address - Country:US
Mailing Address - Phone:610-863-7623
Mailing Address - Fax:610-863-7647
Practice Address - Street 1:547 E WEST ST
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1255
Practice Address - Country:US
Practice Address - Phone:610-863-7623
Practice Address - Fax:610-863-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
50003082OtherCOMMERCIAL BLE CROSS
PA0012412600007Medicaid
PA0012412600007Medicaid