Provider Demographics
NPI:1871543454
Name:DICKSON CITY COMMUNITY AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:DICKSON CITY COMMUNITY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOMENCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-383-1399
Mailing Address - Street 1:2 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1350
Mailing Address - Country:US
Mailing Address - Phone:570-383-1399
Mailing Address - Fax:570-307-1005
Practice Address - Street 1:2 EAGLE LN
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1350
Practice Address - Country:US
Practice Address - Phone:570-383-1399
Practice Address - Fax:570-307-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014112520001Medicaid
PA0568303OtherAETNA
PA000424114195OtherHEALTH PLUS
PAPB4506OtherHEALTH NET
PA224098Medicare PIN
PA0014112520001Medicaid