Provider Demographics
NPI:1114900156
Name:DAYTON AREA AMB SERVICE
Entity Type:Organization
Organization Name:DAYTON AREA AMB SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOCKDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-257-9911
Mailing Address - Street 1:212 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:PA
Mailing Address - Zip Code:16222-5822
Mailing Address - Country:US
Mailing Address - Phone:814-257-9911
Mailing Address - Fax:814-257-9911
Practice Address - Street 1:212 S STATE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:PA
Practice Address - Zip Code:16222-5822
Practice Address - Country:US
Practice Address - Phone:814-257-9911
Practice Address - Fax:814-257-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02186146L00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009117650004Medicaid
PA280064Medicare ID - Type Unspecified