Ickesburg Ambulance Association

Primary specialty

Basic Emergency Medical TechnicianTaxonomy code 146N00000X

License

04274 Issued in PA

Legal business name

ICKESBURG AMBULANCE ASSOCIATION

Practice address

10350 Raccoon Valley Rd
Ickesburg, PA 17037

Phone

(717) 438-3113

NPI assigned

Dec 12, 2006

Last updated

Feb 10, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shane M Wolf

Title

President

Phone

(717) 438-0384

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1023179132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 163",
            "city": "ICKESBURG",
            "state": "PA",
            "postal_code": "170370163",
            "telephone_number": "717-438-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10350 RACCOON VALLEY RD",
            "city": "ICKESBURG",
            "state": "PA",
            "postal_code": "17037",
            "telephone_number": "717-438-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICKESBURG AMBULANCE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "WOLF",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-438-0384"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "PA",
            "license": "04274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001437455",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martzall Counseling and Consulting, LLC
• Julie Martzall, LSW
• Kathleen Susan Webb

• Basic Emergency Medical Technician in Ickesburg, PA
• Providers in Ickesburg, PA by specialty
• Basic Emergency Medical Technician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.