1790763761 NPI number — RESCUE 14 EMS INC

Table of content: (NPI 1790763761)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790763761 NPI number — RESCUE 14 EMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RESCUE 14 EMS 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:
1790763761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 175
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADAMSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15611-0175
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-523-5609
Provider Business Mailing Address Fax Number:
724-527-2755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 EDNA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADAMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15611-9728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-523-5609
Provider Business Practice Location Address Fax Number:
724-527-2755
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMA
Authorized Official First Name:
DON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
724-523-5609

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  02125 , 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: 590002419 . This is a "RR MEDICARE/PALMETTO GBA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 204800 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0009924690001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1009622 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 103537 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 333385 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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