Healthcare Provider Details

I. General information

NPI: 1023373941
Provider Name (Legal Business Name): HAZLETON AMBULETTE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 W 20TH ST
HAZLETON PA
18201-1702
US

IV. Provider business mailing address

724 W 20TH ST
HAZLETON PA
18201-1702
US

V. Phone/Fax

Practice location:
  • Phone: 570-599-4008
  • Fax: 570-300-2308
Mailing address:
  • Phone: 570-599-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number4087154
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CARLOS R. MEJIA
Title or Position: OWNER
Credential:
Phone: 570-599-4008