Provider Demographics
NPI:1144379025
Name:KUTZTOWN AREA TRANSPORT SERVICE INC.
Entity Type:Organization
Organization Name:KUTZTOWN AREA TRANSPORT SERVICE INC.
Other - Org Name:KUTZTOWN AREA AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAKOWIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-683-3012
Mailing Address - Street 1:87 S KEMP RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9737
Mailing Address - Country:US
Mailing Address - Phone:610-683-3012
Mailing Address - Fax:610-683-9161
Practice Address - Street 1:87 S KEMP RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9737
Practice Address - Country:US
Practice Address - Phone:610-683-3012
Practice Address - Fax:610-683-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05061341600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001115729Medicaid
PA001115729Medicaid