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General NPI Number Information
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NPI Number | 1679648877
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Entity Type | Organization
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Legal Business Name | BLAKELY BOROUGH COMMUNITY AMBULANCE ASSOCIATION
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/27/2012
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Provider Practice Location Address
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Address Line | 500 ACADEMY ST
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City | PECKVILLE
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State | PA
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Zip | 18452-1604
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Country | US
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Telephone | 570-307-1279
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Fax | 570-307-1275
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Provider Business Mailing Address
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Address Line | PO BOX 1846
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City | SHAVERTOWN
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State | PA
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Zip | 18708-0846
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Country | US
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Telephone | 570-714-3694
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Fax | 570-714-3695
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Authorized Official
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Title or Position | FINANCIAL SECRETARY
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Name | JEFF CRUCIANI
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Credential |
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Telephone | 570-241-6828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 04061
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License Number State | PA
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