Healthcare Provider Details

I. General information

NPI: 1508892753
Provider Name (Legal Business Name): SCOTT TOWNSHIP HOSE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 MONTDALE ROAD
SCOTT TOWNSHIP PA
18447-9785
US

IV. Provider business mailing address

1027 MONTDALE ROAD
SCOTT TOWNSHIP PA
18447-9785
US

V. Phone/Fax

Practice location:
  • Phone: 570-254-6666
  • Fax: 570-254-6138
Mailing address:
  • Phone: 570-254-6666
  • Fax: 570-254-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04134
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1010226400001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1604587
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBC OF NEPA/ACCESS CARE 2
# 3
Identifier998572
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBC/BS OF NEPA
# 4
Identifier0574448
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA US HEALTHCARE
# 5
Identifier817840
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH

VIII. Authorized Official

Name: MR. ALEXANDER PRITCHYK
Title or Position: PRESIDENT
Credential:
Phone: 570-254-6666