Larksville Commmunity Ambulance

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

03372 Issued in PA

Legal business name

LARKSVILLE COMMMUNITY AMBULANCE

Practice address

480 E State St
Larksville, PA 18651-1407

Phone

(570) 779-4778

Fax

(570) 779-4828

NPI assigned

Sep 23, 2005

Last updated

Apr 8, 2008By 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

Mrs. Susan M Stevenson, EMT

Title

Captain

Phone

(570) 779-4828

Specialties & licenses 1

Addresses

Other identifiers 10

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": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1669468732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181050207",
            "telephone_number": "484-664-2007",
            "fax_number": "484-664-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 E STATE ST",
            "city": "LARKSVILLE",
            "state": "PA",
            "postal_code": "186511407",
            "telephone_number": "570-779-4778",
            "fax_number": "570-779-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARKSVILLE COMMMUNITY AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "570-779-4828",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "EMT"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "03372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF PA BLUE SHIELD",
            "identifier": "222759",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA HEALTH & RETIREMENT",
            "identifier": "811529",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS HEALTH NET COMMERCIAL",
            "identifier": "PB4425",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHS HEALTH PLAN HMO MDC",
            "identifier": "PB4425",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA MEDICAID",
            "identifier": "0015286200003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA USHC BLUE BELL HMO",
            "identifier": "0471301",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH",
            "identifier": "080816",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACS HEALTH NET HMO MDC",
            "identifier": "PB4425",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHS HEALTH PLAN COMMERCIA",
            "identifier": "PB4425",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUALMED",
            "identifier": "PB4425",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; 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.