Provider Demographics
NPI:1437226420
Name:FAYETTE EMS
Entity Type:Organization
Organization Name:FAYETTE EMS
Other - Org Name:FAYETTE EMERGENCY MEDICAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-628-8610
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:301 ARCH SREET
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-0862
Mailing Address - Country:US
Mailing Address - Phone:724-628-8610
Mailing Address - Fax:724-628-2533
Practice Address - Street 1:301 S ARCH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3521
Practice Address - Country:US
Practice Address - Phone:724-628-8610
Practice Address - Fax:724-628-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA262153416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1498717OtherUMWA
PA204435OtherUPMC
PA0015252900003Medicaid
PA38334OtherCOVERTRY HUMINA
PA1020392OtherGATEWAY
PA75204OtherUNISON
PA1498717OtherUMWA
PA75204OtherUNISON