Organization
A VITAL RESPONSE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY M MOENCH (CHIEF OF OPERATIONS)
(717) 207-7780
Entity
Organization
Contact information
Practice address
1205 S 28TH ST, HARRISBURG, PA 17111-1046
(717) 207-7780
(717) 754-0011
Mailing address
1205 S 28TH ST, HARRISBURG, PA 17111-1046
(717) 207-7780
(717) 754-0011
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
06006
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009029000
INDEPENDANCE BLUE CROSS
PA
01
—
001860315
HIGHMARK BLUE SHIELD PA
PA
05
—
101535548
—
PA
Enumeration date
06/25/2006
Last updated
03/24/2015
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