Pond Hill Lily Lake Ambulance Association

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

POND HILL LILY LAKE AMBULANCE ASSOCIATION

Practice address

421 Pond Hill Mountain Rd
Wapwallopen, PA 18660-1214

Phone

(570) 379-2292

Fax

(570) 379-2292

NPI assigned

Jun 8, 2006

Last updated

Dec 22, 2015By 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

Mary I Balliet

Title

Captain

Phone

(570) 379-2292

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1073553822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 POND HILL MOUNTAIN RD",
            "city": "WAPWALLOPEN",
            "state": "PA",
            "postal_code": "186601214",
            "telephone_number": "570-379-2292",
            "fax_number": "570-379-2292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 POND HILL MOUNTAIN RD",
            "city": "WAPWALLOPEN",
            "state": "PA",
            "postal_code": "186601214",
            "telephone_number": "570-379-2292",
            "fax_number": "570-379-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POND HILL LILY LAKE AMBULANCE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "BALLIET",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "570-379-2292"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NEPA MAJ MED",
            "identifier": "998574",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACCESS CARE II PPO",
            "identifier": "289707",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103047580001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG PROGRA",
            "identifier": "610492700",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Land Ambulance in Wapwallopen, PA
• Providers in Wapwallopen, PA by specialty
• Land Ambulance in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2015; 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.