Provider Demographics
NPI:1720061997
Name:BENNETT'S VALLEY AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:BENNETT'S VALLEY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-637-5725
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15849-0048
Mailing Address - Country:US
Mailing Address - Phone:814-637-5725
Mailing Address - Fax:814-637-5512
Practice Address - Street 1:12479 BENNETTS VALLEY HIGHWAY
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:PA
Practice Address - Zip Code:15849-0048
Practice Address - Country:US
Practice Address - Phone:814-637-5725
Practice Address - Fax:814-637-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA75233144251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA283796Medicare UPIN