Provider Demographics
NPI:1023001369
Name:MURRYSVILLE MEDIC NO 1
Entity Type:Organization
Organization Name:MURRYSVILLE MEDIC NO 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DARRICK
Authorized Official - Last Name:GERANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-325-4003
Mailing Address - Street 1:4158 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1939
Mailing Address - Country:US
Mailing Address - Phone:724-325-4003
Mailing Address - Fax:724-325-1603
Practice Address - Street 1:3237 SARDIS RD
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1230
Practice Address - Country:US
Practice Address - Phone:724-327-1222
Practice Address - Fax:724-327-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010067060001Medicaid
PA0010067060001Medicaid
PA280743Medicare ID - Type Unspecified