Active NPI
Kettle Creek Ambulance Association
- Land Ambulance
- Cross Fork, PA
National Provider Identifier
1669678314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- Legal business name
- KETTLE CREEK AMBULANCE ASSOCIATION
- Practice address
- 7 Firehouse Lane
Cross Fork, PA 17729-0289 - Phone
- (570) 923-2111
- Fax
- (570) 923-9900
- NPI assigned
- Jun 21, 2007
- Last updated
- Aug 29, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nancy Dingman, EMT
- Title
- President
- Phone
- (570) 923-2111
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | Primary |
Addresses
Primary practice location
7 Firehouse Lane
Cross Fork, PA 17729-0289
Mailing address
PO Box 289
Cross Fork, PA 17729-0289
Phone (570) 923-2111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1021552940001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050210000227 | PA | Part B Supplier - Ambulance Service Supplier | 8426009192 | Practice locations: Cross Fork, PA |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1219968000000",
"number": "1669678314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 289",
"city": "CROSS FORK",
"state": "PA",
"postal_code": "177290289",
"telephone_number": "570-923-2111",
"fax_number": "570-923-9900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7 FIREHOUSE LANE",
"city": "CROSS FORK",
"state": "PA",
"postal_code": "177290289",
"telephone_number": "570-923-2111",
"fax_number": "570-923-9900"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KETTLE CREEK AMBULANCE ASSOCIATION",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-21",
"last_updated": "2008-08-29",
"status": "A",
"authorized_official_last_name": "DINGMAN",
"authorized_official_first_name": "NANCY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "570-923-2111",
"authorized_official_credential": "EMT"
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1021552940001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cross Fork, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.