Healthcare Provider Details

I. General information

NPI: 1861480949
Provider Name (Legal Business Name): PLAINS VOLUNTEER AMBULANCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAFFETT ST
PLAINS PA
18705-1933
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 570-822-9279
  • Fax: 570-223-6226
Mailing address:
  • Phone: 484-664-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03366
License Number StatePA

VIII. Authorized Official

Name: MR. PAUL A ZABRISKI
Title or Position: TREASURER
Credential:
Phone: 570-822-9279