=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376611954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANKLIN AND NORTHMORELAND TOWNSHIPS AMBULANCE ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2006
-----------------------------------------------------
Last Update Date | 04/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 329 ORANGE RD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18612-9308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-333-0928
-----------------------------------------------------
Fax | 570-333-0925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1846
-----------------------------------------------------
City | SHAVERTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18708-0846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-714-3694
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CAPTAIN
-----------------------------------------------------
Name | RICHARD BARTHOLOMEW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-333-4672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 99125
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------