Organization
LARKSVILLE COMMMUNITY AMBULANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN M STEVENSON EMT (CAPTAIN)
(570) 779-4828
Entity
Organization
Contact information
Practice address
480 E STATE ST, LARKSVILLE, PA 18651-1407
(570) 779-4778
(570) 779-4828
Mailing address
PO BOX 207, ALLENTOWN, PA 18105-0207
(484) 664-2007
(484) 664-2015
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
03372
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015286200003
PA MEDICAID
—
01
—
0471301
AETNA USHC BLUE BELL HMO
—
01
—
080816
FIRST PRIORITY HEALTH
—
01
—
222759
BC BS OF PA BLUE SHIELD
—
01
—
811529
UMWA HEALTH & RETIREMENT
—
01
—
PB4425
ACS HEALTH NET HMO MDC
—
Enumeration date
09/23/2005
Last updated
04/08/2008
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