=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841224037
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERWICK AREA AMBULANCE ASSOCIATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 05/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2018 N VINE ST
-----------------------------------------------------
City | BERWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18603-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-752-5321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2018 N VINE ST
-----------------------------------------------------
City | BERWICK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18603-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-752-5321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANGELO C VENDITTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-752-5321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 05231
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------