Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 341600000X | Ambulance | | 04164 | PENNSYLVANIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 0077296000 | OTHER | PENNSYLVANIA | INDEPENDENCE BC ID |
| 2 | 35511 | OTHER | PENNSYLVANIA | HEALTH PARTNERS ID |
| 3 | 998575 | OTHER | PENNSYLVANIA | BLUE CROSS NEPA |
| 4 | 1007506200003 | MEDICAID | PENNSYLVANIA | |
| 5 | 206068 | OTHER | PENNSYLVANIA | FEDERAL BCBS ID |
| 6 | 02635725 | MEDICAID | NEW YORK | |
| 7 | 807228 | OTHER | PENNSYLVANIA | FIRST PRIORITY |
| 8 | 590012824 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | RAILROAD MEDICARE ID |
| 9 | 4076133 00 | MEDICAID | MARYLAND | |
| 10 | 1539617 | OTHER | PENNSYLVANIA | GATEWAY |
| 11 | 011626 | MEDICARE ID-TYPE UNSPECIFIED | PENNSYLVANIA | HIGHMARK MEDICARE SVCS |
| 12 | 359796600 | OTHER | PENNSYLVANIA | OWCP ID |
| 13 | 080017000 | OTHER | PENNSYLVANIA | FEDERAL BLACK LUNG ID |
| 14 | 000000096978 | OTHER | PENNSYLVANIA | THREE RIVERS HLTH PLN |
