Provider Demographics
NPI:1093953176
Name:BRADFORD AREA TRANSPORT SERVICE, LLC
Entity Type:Organization
Organization Name:BRADFORD AREA TRANSPORT SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCRIVO
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:814-598-1392
Mailing Address - Street 1:17 HOLLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1809
Mailing Address - Country:US
Mailing Address - Phone:814-598-2089
Mailing Address - Fax:814-368-8460
Practice Address - Street 1:17 HOLLEY AVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-1809
Practice Address - Country:US
Practice Address - Phone:814-598-2089
Practice Address - Fax:814-368-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA090023416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00688496OtherRAILROAD MEDICARE
PA102254327Medicaid
NY03103179Medicaid
PA2092305OtherHIGHMARK BLUE CROSS/BLUE SHIELD
PA145094Medicare PIN