Healthcare Provider Details

I. General information

NPI: 1518951755
Provider Name (Legal Business Name): GILBERTSVILLE AREA COMMUNITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 JACKSON RD
GILBERTSVILLE PA
19525-9529
US

IV. Provider business mailing address

91 JACKSON RD PO BOX 332
GILBERTSVILLE PA
19525-9529
US

V. Phone/Fax

Practice location:
  • Phone: 610-367-9191
  • Fax: 610-369-3931
Mailing address:
  • Phone: 610-367-9191
  • Fax: 610-369-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03250
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN M. KOLTONUK
Title or Position: PRESIDENT BOARD OF DIRECTORS
Credential:
Phone: 610-367-9191