Jefferson Township Volunteer Ambulance

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

98322 Issued in PA

Legal business name

JEFFERSON TOWNSHIP VOLUNTEER AMBULANCE

Practice address

1980 Moosic Lake Rd
Jefferson Township, PA 18436-3203

Phone

(570) 698-0479

Fax

(570) 689-4703

NPI assigned

Dec 11, 2006

Last updated

Apr 2, 2020By 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

Daniel Corallo

Title

Captain

Phone

(570) 840-4057

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585785600000",
    "number": "1952461105",
    "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": "570-477-1900",
            "fax_number": "570-608-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 MOOSIC LAKE RD",
            "city": "JEFFERSON TOWNSHIP",
            "state": "PA",
            "postal_code": "184363203",
            "telephone_number": "570-698-0479",
            "fax_number": "570-689-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON TOWNSHIP VOLUNTEER AMBULANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-04-02",
        "certification_date": "2020-04-02",
        "status": "A",
        "authorized_official_last_name": "CORALLO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CAPTAIN",
        "authorized_official_telephone_number": "570-840-4057"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "98322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012569140002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberlee Lyn Gevaras, FNP
• Christel Gillette
• Daniel Luis Hawthorn, RN
• Susan G Hayden, MS, CCC-SLP
• Erin James, OT
• Jeanna Sebastianelli, MA, LBS, LPC

• Land Ambulance in Jefferson Township, PA
• Providers in Jefferson Township, 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 2, 2020; 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.