Provider Demographics
NPI:1124010293
Name:SHENANDOAH COMMUNITY AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:SHENANDOAH COMMUNITY AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:EXAMITAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-462-0500
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-0726
Mailing Address - Country:US
Mailing Address - Phone:717-214-6018
Mailing Address - Fax:717-214-6020
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:PA
Practice Address - Zip Code:17976-1705
Practice Address - Country:US
Practice Address - Phone:570-462-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA012913416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001058990Medicaid