Provider Demographics
NPI:1063462612
Name:GOULDSBORO AMBULANCE SQUAD INC
Entity Type:Organization
Organization Name:GOULDSBORO AMBULANCE SQUAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:RINALDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-842-4175
Mailing Address - Street 1:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:GOULDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18424-0255
Mailing Address - Country:US
Mailing Address - Phone:570-842-4175
Mailing Address - Fax:570-842-1516
Practice Address - Street 1:490 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOULDSBORO
Practice Address - State:PA
Practice Address - Zip Code:18424-8836
Practice Address - Country:US
Practice Address - Phone:570-842-4175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015841830001Medicaid
590013515Medicare PIN
PA0015841830001Medicaid