Provider Demographics
NPI:1033289715
Name:FREEPORT EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:FREEPORT EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-295-2980
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:400 MARKET ST
Mailing Address - City:FREEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16229-0158
Mailing Address - Country:US
Mailing Address - Phone:724-295-2980
Mailing Address - Fax:724-295-2970
Practice Address - Street 1:400 MARKET ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:PA
Practice Address - Zip Code:16229-1122
Practice Address - Country:US
Practice Address - Phone:724-295-2300
Practice Address - Fax:724-295-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0131693416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
285818OtherHIGHMARK
80049OtherBLACK LUNG
PA95604Medicaid
PA0009601420001Medicaid
35696OtherHEALTH AMERICA
7258007OtherAETNA US HEALTHCARE
PA1529059Medicaid
463672OtherCOMBINED INS. CO OF AMER
V0V097OtherUPMC
PA0009601420001Medicaid
35696OtherHEALTH AMERICA
0105511Medicare ID - Type UnspecifiedUMWA