Organization
FORTY FORT COMMUNITY AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE OHARA (PRESIDENT)
(570) 288-1671
Entity
Organization
Contact information
Practice address
1271 WYOMING AVE, FORTY FORT, PA 18704-4101
(570) 288-1671
Mailing address
PO BOX 1846, SHAVERTOWN, PA 18708-0846
(570) 714-3694
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
05168
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800360
FEDERAL BLACK LUNG
—
Enumeration date
12/01/2006
Last updated
08/22/2020
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