Provider Demographics
NPI:1871591545
Name:FORKS TOWNSHIP EMERGENCY SQUAD
Entity type:Organization
Organization Name:FORKS TOWNSHIP EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NUTTALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-253-7416
Mailing Address - Street 1:PO BOX 284
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18044-0284
Mailing Address - Country:US
Mailing Address - Phone:610-253-7416
Mailing Address - Fax:610-253-9550
Practice Address - Street 1:2016 SULLIVAN TRL
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18040-8338
Practice Address - Country:US
Practice Address - Phone:610-253-7416
Practice Address - Fax:610-253-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04112341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA281108Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER