NPIMap

Organization Active NPI

Laceyville Ambulance Association

  • Land Ambulance
  • Laceyville, PA
National Provider Identifier
1215120019
Registry record updated Oct 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
05178 Issued in PA
Legal business name
LACEYVILLE AMBULANCE ASSOCIATION
Practice address
12 East Main Street
Laceyville, PA 18623
Phone
(570) 282-5652
Fax
(570) 282-5653
NPI assigned
Aug 24, 2007
Last updated
Oct 14, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2009

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

Authorized official

Name
Mr. Eric Ryan Shafer
Title
Captain
Phone
(570) 869-2778

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X
Land Ambulance 3416L0300X 05178 PA Primary

Addresses

Primary practice location

12 East Main Street
Laceyville, PA 18623

Mailing address

PO Box 274
Laceyville, PA 18623-0274
Phone (570) 282-5652

Other identifiers 1

IdentifierTypeStateIssuer
0012067070001MedicaidPA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255478400000",
    "number": "1215120019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 274",
            "city": "LACEYVILLE",
            "state": "PA",
            "postal_code": "186230274",
            "telephone_number": "570-282-5652",
            "fax_number": "570-282-5653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 EAST MAIN STREET",
            "city": "LACEYVILLE",
            "state": "PA",
            "postal_code": "18623",
            "telephone_number": "570-282-5652",
            "fax_number": "570-282-5653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACEYVILLE AMBULANCE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2009-10-14",
        "status": "A",
        "authorized_official_last_name": "SHAFER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "570-869-2778",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "05178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012067070001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laceyville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2009; 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.