Provider Demographics
NPI:1235286097
Name:SOUTHSIDE AREA AMBULANCE ASSOCIATION INC
Entity Type:Organization
Organization Name:SOUTHSIDE AREA AMBULANCE ASSOCIATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WIDGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-204-4695
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:CATAWISSA
Mailing Address - State:PA
Mailing Address - Zip Code:17820-0141
Mailing Address - Country:US
Mailing Address - Phone:570-204-4695
Mailing Address - Fax:570-356-2765
Practice Address - Street 1:400 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CATAWISSA
Practice Address - State:PA
Practice Address - Zip Code:17820-1043
Practice Address - Country:US
Practice Address - Phone:570-204-4695
Practice Address - Fax:570-356-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012522900004Medicaid
PA0012522900004Medicaid
P00742856Medicare PIN