1598786931 NPI number — MEADVILLE AREA AMBULANCE SERVICE LLC

Table of content: (NPI 1598786931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598786931 NPI number — MEADVILLE AREA AMBULANCE SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADVILLE AREA AMBULANCE SERVICE LLC
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:
1598786931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
872 WATER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEADVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16335-3455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-724-7598
Provider Business Mailing Address Fax Number:
814-337-1153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
872 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEADVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16335-3455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-724-7598
Provider Business Practice Location Address Fax Number:
814-337-1153
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
814-724-7598

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1010125550001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241887 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001629049 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010125550001 . This is a "ION HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 606018100 . This is a "FEDERAL BLACK LUNG PROGRAM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2305927000 . This is a "INDEPENDENCE BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 606018100 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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