Healthcare Provider Details

I. General information

NPI: 1578559555
Provider Name (Legal Business Name): KULPMONT COMMUNITY AMB ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 N 8TH ST
KULPMONT PA
17834-1343
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 570-373-1103
  • Fax:
Mailing address:
  • Phone: 800-473-2278
  • Fax: 484-664-2017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EDWARD R OHEARN
Title or Position: TREASURER
Credential: EMT
Phone: 570-373-1103