MEDICARE: GILBERTSVILLE AREA COMMUNITY AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	03250	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14619	OTHER		HEALTH PARTNERS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518951755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILBERTSVILLE AREA COMMUNITY AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	91 JACKSON RD
Second Line	:	PO BOX 332
City	:	GILBERTSVILLE
State	:	PA
Zip	:	19525-9529
Country	:	US
Telephone Number	:	610-367-9191
Fax Number	:	610-369-3931

Provider Business Practice Location Address
First Line	:	91 JACKSON RD
Second Line	:
City	:	GILBERTSVILLE
State	:	PA
Zip	:	19525-9529
Country	:	US
Telephone Number	:	610-367-9191
Fax Number	:	610-369-3931

Authorized Official
Title or Position	:	PRESIDENT BOARD OF DIRECTORS
Name	:	MR. JOHN M. KOLTONUK
Credential	:
Telephone Number	:	610-367-9191

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	02/25/2015

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