Blakely Borough Community Ambulance Association

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

04061 Issued in PA

Legal business name

BLAKELY BOROUGH COMMUNITY AMBULANCE ASSOCIATION

Doing business as

Bakely EMS & Rescue

Practice address

500 Academy St
Peckville, PA 18452-1604

Phone

(570) 307-1279

Fax

(570) 307-1275

NPI assigned

Nov 22, 2006

Last updated

Aug 27, 2012By 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

Jeff Cruciani

Title

Financial Secretary

Phone

(570) 241-6828

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Bakely EMS & Rescue 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": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346025600000",
    "number": "1679648877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1846",
            "city": "SHAVERTOWN",
            "state": "PA",
            "postal_code": "187080846",
            "telephone_number": "570-714-3694",
            "fax_number": "570-714-3695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 ACADEMY ST",
            "city": "PECKVILLE",
            "state": "PA",
            "postal_code": "184521604",
            "telephone_number": "570-307-1279",
            "fax_number": "570-307-1275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKELY BOROUGH COMMUNITY AMBULANCE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2012-08-27",
        "status": "A",
        "authorized_official_last_name": "CRUCIANI",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "FINANCIAL SECRETARY",
        "authorized_official_telephone_number": "570-241-6828"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "04061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM BLUE",
            "identifier": "287403",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012562900002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "899215",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bakely EMS & Rescue",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lee T Besen, MD
• Biancarellis Pharmacy (Biancarelli's Pharmacy, LLC)
• Dana Bigelow, COTA
• Judi Biglin
• Joseph Birtel, PTA
• Blakely Emergency Group PC
• Randall George Brundage, DO
• John Francis Bushta, DPM
• Emily Elizabeth Byers, PA-C
• Emily Cardona, NCC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; 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.