Provider Demographics
NPI:1003998824
Name:BRENTWOOD EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:BRENTWOOD EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:BALKOVEC
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-P
Authorized Official - Phone:412-884-8740
Mailing Address - Street 1:3624 BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-3153
Mailing Address - Country:US
Mailing Address - Phone:412-884-8740
Mailing Address - Fax:412-884-8681
Practice Address - Street 1:3624 BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-3153
Practice Address - Country:US
Practice Address - Phone:412-884-8740
Practice Address - Fax:412-884-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03125146L00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590002470OtherTRC
PA280983OtherBCBS
PA5922183OtherAETNA US HEALTHCARE
PA0010027700001Medicaid
PA201296OtherUPMC
PA00000075131OtherTHREE RIVERS
PA1005476OtherGATEWAY
PA1647OtherADVANTRA
PA280983Medicare ID - Type Unspecified