Provider Demographics
NPI:1124039896
Name:FORT CHERRY AMBULANCE INC
Entity Type:Organization
Organization Name:FORT CHERRY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-926-7201
Mailing Address - Street 1:8200 NOBLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2218
Mailing Address - Country:US
Mailing Address - Phone:724-926-7201
Mailing Address - Fax:724-926-2577
Practice Address - Street 1:8200 NOBLESTOWN RD
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-2218
Practice Address - Country:US
Practice Address - Phone:724-926-7201
Practice Address - Fax:724-926-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04170341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019174040001Medicaid
PA097970Medicare PIN