Organization
POND HILL LILY LAKE AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY I BALLIET (CAPTAIN)
(570) 379-2292
Entity
Organization
Contact information
Practice address
421 POND HILL MOUNTAIN RD, WAPWALLOPEN, PA 18660-1214
(570) 379-2292
(570) 379-2292
Mailing address
421 POND HILL MOUNTAIN RD, WAPWALLOPEN, PA 18660-1214
(570) 379-2292
(570) 379-2292
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103047580001
—
PA
01
—
289707
ACCESS CARE II PPO
PA
01
—
610492700
FEDERAL BLACK LUNG PROGRA
PA
01
—
998574
BLUE CROSS NEPA MAJ MED
PA
Enumeration date
06/08/2006
Last updated
12/22/2015
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