Healthcare Provider Details

I. General information

NPI: 1679569735
Provider Name (Legal Business Name): BIG VALLEY AMBULANCE CLUB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E MAIN ST
BELLEVILLE PA
17004-9256
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 717-935-2317
  • Fax: 717-935-2317
Mailing address:
  • Phone: 800-473-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03218
License Number StatePA

VIII. Authorized Official

Name: MRS. JOY C BYLER
Title or Position: PRESIDENT
Credential: EMT
Phone: 717-935-2290