Healthcare Provider Details

I. General information

NPI: 1093880262
Provider Name (Legal Business Name): WEST PITTSTON COMMUNITY AMBULANCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 TUNKHANNOCK AVE
WEST PITTSTON PA
18643-1223
US

IV. Provider business mailing address

PO BOX 1846
SHAVERTOWN PA
18708-0846
US

V. Phone/Fax

Practice location:
  • Phone: 570-654-2747
  • Fax:
Mailing address:
  • Phone: 570-714-3694
  • Fax: 570-714-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number04271
License Number StatePA

VIII. Authorized Official

Name: JANE FIRESTINE
Title or Position: TREASURER
Credential:
Phone: 570-655-9122