Provider Demographics
NPI:1174681407
Name:NEWPORT AMBULANCE LEAGUE
Entity Type:Organization
Organization Name:NEWPORT AMBULANCE LEAGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-567-6917
Mailing Address - Street 1:50 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074-1408
Mailing Address - Country:US
Mailing Address - Phone:717-567-6917
Mailing Address - Fax:
Practice Address - Street 1:50 S 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-1408
Practice Address - Country:US
Practice Address - Phone:717-567-6917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03294146N00000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007659340005Medicaid
PA0007659340005Medicaid