Provider Demographics
NPI:1306845136
Name:MADERA VOLUNTEER AMBULANCE SERVICE
Entity Type:Organization
Organization Name:MADERA VOLUNTEER AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-378-8777
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:RTE 53 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:PA
Practice Address - Zip Code:16661
Practice Address - Country:US
Practice Address - Phone:814-378-8777
Practice Address - Fax:814-378-5797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050473416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA281371Medicare ID - Type Unspecified