Provider Demographics
NPI:1063452324
Name:PENN MAHONING AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:PENN MAHONING AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOMBE
Authorized Official - Suffix:
Authorized Official - Credentials:EMT/B
Authorized Official - Phone:570-386-2233
Mailing Address - Street 1:P.O.BOX 135
Mailing Address - Street 2:
Mailing Address - City:ANDREAS
Mailing Address - State:PA
Mailing Address - Zip Code:18211-0135
Mailing Address - Country:US
Mailing Address - Phone:570-386-2233
Mailing Address - Fax:570-386-4128
Practice Address - Street 1:1748 WEST PENN PIKE
Practice Address - Street 2:
Practice Address - City:NEW RINGGOLD
Practice Address - State:PA
Practice Address - Zip Code:17960-9401
Practice Address - Country:US
Practice Address - Phone:570-386-2233
Practice Address - Fax:570-386-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001160546 0001Medicaid
PA001160546 0001Medicaid