1770521916 NPI number — PRIORITY ONE MEDICAL TRANSPORT, INC.

Table of content: (NPI 1770521916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770521916 NPI number — PRIORITY ONE MEDICAL TRANSPORT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIORITY ONE MEDICAL TRANSPORT, 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:
6
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:
1770521916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1119 BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST MC KEESPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15035-1517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-823-4980
Provider Business Mailing Address Fax Number:
412-823-4917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1119 BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MC KEESPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15035-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-823-4980
Provider Business Practice Location Address Fax Number:
412-823-4917
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KOLESAR-PEPPLER
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
412-823-4980

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03127 , 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: 239347 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007683580004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 029745 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 239347 . This is a "HIGHMARK BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 590013955 . This is a "RR MEDICAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100742629003 , issued by the state of ( PW ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1007683580006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1504971 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 252545 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".




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