1033289715 NPI number — FREEPORT EMERGENCY MEDICAL SERVICES INC

Table of content: (NPI 1033289715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033289715 NPI number — FREEPORT EMERGENCY MEDICAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREEPORT EMERGENCY MEDICAL SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033289715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
400 MARKET ST
Provider Business Mailing Address City Name:
FREEPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16229-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-295-2980
Provider Business Mailing Address Fax Number:
724-295-2970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16229-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-295-2300
Provider Business Practice Location Address Fax Number:
724-295-2970
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RENNICK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OPERATIONS SUPERVISOR
Authorized Official Telephone Number:
724-295-2980

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  013169 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 285818 . This is a "HIGHMARK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80049 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95604 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009601420001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35696 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7258007 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1529059 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 463672 . This is a "COMBINED INS. CO OF AMER" identifier . This identifiers is of the category "OTHER".
  • Identifier: V0V097 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com