MEDICARE: COMMUNITY AMBULANCE SERVICE CLUB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	04141	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590007322	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	50004678	OTHER	PA	CAPITAL BLUE CROSS
4	0130130	OTHER	PA	THREE RIVERS
5	50004678	OTHER	PA	KEYSTONE SENIOR BLUE
6	893120	OTHER	PA	BLACK LUNG PROGRAM
7	20018661	OTHER	PA	AMERIHEALTH MERCY

General Provider Information

NPI Number	:	1962538900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY AMBULANCE SERVICE CLUB

Provider Business Mailing Address
First Line	:	PO BOX 33
Second Line	:
City	:	TOWER CITY
State	:	PA
Zip	:	17980-0033
Country	:	US
Telephone Number	:	717-647-2271
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 EAST COLLIERY AVENUE
Second Line	:
City	:	TOWER CITY
State	:	PA
Zip	:	17980
Country	:	US
Telephone Number	:	717-943-8013
Fax Number	:	717-647-2546

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEREMIAH A DEITER
Credential	:
Telephone Number	:	717-943-8013

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	09/15/2015

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Directions to “COMMUNITY AMBULANCE SERVICE CLUB ” Practice Location

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