1003998824 NPI number — BRENTWOOD EMERGENCY MEDICAL SERVICES

Table of content: (NPI 1003998824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003998824 NPI number — BRENTWOOD EMERGENCY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENTWOOD EMERGENCY MEDICAL SERVICES
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:
1003998824
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3624 BROWNSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15227-3153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-884-8740
Provider Business Mailing Address Fax Number:
412-884-8681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3624 BROWNSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15227-3153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-884-8740
Provider Business Practice Location Address Fax Number:
412-884-8681
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALKOVEC
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
NICHOLAS
Authorized Official Title or Position:
OPERATIONS SUPERVISOR
Authorized Official Telephone Number:
412-884-8740

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , with the licence number:  03125 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 146L00000X , with the licence number: 03125 , 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: 590002470 . This is a "TRC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 280983 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5922183 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010027700001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201296 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00000075131 . This is a "THREE RIVERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1005476 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1647 . This is a "ADVANTRA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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