Healthcare Provider Details

I. General information

NPI: 1891137568
Provider Name (Legal Business Name): SCRANTON QUINCY AMBULANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 REMINGTON AVE
SCRANTON PA
18505-1118
US

IV. Provider business mailing address

4000 MERIDIAN BLVD
FRANKLIN TN
37067-6325
US

V. Phone/Fax

Practice location:
  • Phone: 570-558-4911
  • Fax:
Mailing address:
  • Phone: 615-465-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number13016
License Number StatePA

VII. Legacy identifiers

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

# 1
IdentifierP01264050
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier102878813 0004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier831195
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY

VIII. Authorized Official

Name: JENNIFER L JACKSON
Title or Position: SENIOR DIRECTOR, ENROLLMENT
Credential:
Phone: 877-892-9815