MEDICARE: WEST HAZLETON COMMUNITY AMBULANCE ASSN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740272426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST HAZLETON COMMUNITY AMBULANCE ASSN

Provider Business Mailing Address
First Line	:	111 E. CRANBERRY AVE.
Second Line	:
City	:	WEST HAZELTON
State	:	PA
Zip	:	18202-3845
Country	:	US
Telephone Number	:	570-455-5221
Fax Number	:	570-455-1207

Provider Business Practice Location Address
First Line	:	111 E. CRANBERRY AVE.
Second Line	:
City	:	WEST HAZELTON
State	:	PA
Zip	:	18202-3845
Country	:	US
Telephone Number	:	570-455-5221
Fax Number	:	570-455-1207

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MELISSA M. LONGAZEL
Credential	:
Telephone Number	:	570-459-0310

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	01/09/2014

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