Provider Demographics
NPI:1396862967
Name:GREATER COLUMBIA MEDICAL TRANSPORT SERVICE, LLP
Entity Type:Organization
Organization Name:GREATER COLUMBIA MEDICAL TRANSPORT SERVICE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER'S REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-207-6740
Mailing Address - Street 1:315 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2546
Mailing Address - Country:US
Mailing Address - Phone:570-207-6740
Mailing Address - Fax:570-207-6749
Practice Address - Street 1:1 S HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1476
Practice Address - Country:US
Practice Address - Phone:570-389-1056
Practice Address - Fax:570-389-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05172341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01759664Medicaid
PA027482Medicare ID - Type UnspecifiedAMBULANCE PROVIDER