Citizens Hose Company of Jersey Shore

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

03012 Issued in PA

Legal business name

CITIZENS HOSE COMPANY OF JERSEY SHORE

Practice address

1212 Locust St
Jersey Shore, PA 17740-1920

Phone

(570) 398-7471

Fax

(570) 398-3520

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Lloyd Forcey

Title

Treasurer

Phone

(570) 398-4790

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Jersey Shore Area EMS Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1497824049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 LOCUST ST",
            "address_2": "PO BOX 5086",
            "city": "JERSEY SHORE",
            "state": "PA",
            "postal_code": "177401920",
            "telephone_number": "570-398-7471",
            "fax_number": "570-398-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 LOCUST ST",
            "city": "JERSEY SHORE",
            "state": "PA",
            "postal_code": "177401920",
            "telephone_number": "570-398-7471",
            "fax_number": "570-398-3520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITIZENS HOSE COMPANY OF JERSEY SHORE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "FORCEY",
        "authorized_official_first_name": "LLOYD",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "570-398-4790",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "146L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "146N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medical Technician, Basic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "03012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011047800002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jersey Shore Area EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kiersten Leigh Betz, RT (R), PA-C
• Catherine A Brosius-Bolick, DO
• Amanda Lee Cagle, PHARMD
• Kirkland Campbell
• Nathan James Carpenter, DC
• Leita Faye Clark, COTA/L
• Thomas Carroll Connolly, M.D.
• Jonathan David Coote Jr., PA-C
• Crystal Renea Corl, COTA/L
• Reynaldo Navarro Cornel, M.D.

• Land Ambulance in Jersey Shore, PA
• Providers in Jersey Shore, PA by specialty
• Land Ambulance in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.