Healthcare Provider Details

I. General information

NPI: 1821032061
Provider Name (Legal Business Name): DELAWARE TOWNSHIP VOLUNTEER AMBULANCE CORP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PARK RD
DINGMANS FERRY PA
18328
US

IV. Provider business mailing address

PO BOX 186
DINGMANS FERRY PA
18328-0186
US

V. Phone/Fax

Practice location:
  • Phone: 570-828-2345
  • Fax:
Mailing address:
  • Phone: 570-828-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012648900001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MARY L CORBETT
Title or Position: CAPTAIN
Credential:
Phone: 570-828-2345