MEDICARE: BIG VALLEY AMBULANCE CLUB, INC.

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	03218	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	590007653	OTHER		UNITED HC RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0289335	OTHER		KEYSTONE HP CTRL HMO MDC
2	46137	OTHER		GHP
3	0289335	OTHER		KEYSTONE HP CTRL COMM.
4	2346118	OTHER		AETNA USHC BLUE BELL HMO
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	289335	OTHER	PA	BCBS OF PA

General Provider Information

NPI Number	:	1679569735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG VALLEY AMBULANCE CLUB, INC.

Provider Business Mailing Address
First Line	:	PO BOX 207
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-0207
Country	:	US
Telephone Number	:	800-473-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	4371 E MAIN ST
Second Line	:
City	:	BELLEVILLE
State	:	PA
Zip	:	17004-9256
Country	:	US
Telephone Number	:	717-935-2317
Fax Number	:	717-935-2317

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JOY C BYLER
Credential	:	EMT
Telephone Number	:	717-935-2290

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/28/2012

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Directions to “BIG VALLEY AMBULANCE CLUB, INC. ” Practice Location

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