Provider Demographics
NPI:1033180559
Name:PENN TOWNSHIP AMBULANCE ASSOCIATION RESCUE NO 6
Entity Type:Organization
Organization Name:PENN TOWNSHIP AMBULANCE ASSOCIATION RESCUE NO 6
Other - Org Name:PENN TWP AMBULANCE RESCUE 6
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-744-4112
Mailing Address - Street 1:1030 SANDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-4700
Mailing Address - Country:US
Mailing Address - Phone:724-744-4112
Mailing Address - Fax:724-744-4599
Practice Address - Street 1:1030 SANDY HILL RD
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-4700
Practice Address - Country:US
Practice Address - Phone:724-744-4112
Practice Address - Fax:724-744-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007168870002Medicaid
PA590130845OtherRR MEDICARE/PALMETTO GBA
PA000000067301OtherUNISON HEATH PLAN
PA103546OtherUPMC HEALTH PLAN
PA288698OtherBLUE CROSS/BLUE SHIELD
PA1021810OtherGATEWAY HEALTH PLAN
PA8517OtherHEALTH AMERICA
PA000000067301OtherUNISON HEATH PLAN
PA0007168870002Medicaid