Provider Demographics
NPI:1447220751
Name:CONNEAUT LAKE AREA AMBULANCE SERVICE
Entity Type:Organization
Organization Name:CONNEAUT LAKE AREA AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MADEIRA
Authorized Official - Middle Name:T
Authorized Official - Last Name:PARASKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-382-1133
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:16316-0546
Mailing Address - Country:US
Mailing Address - Phone:814-382-1133
Mailing Address - Fax:814-382-9285
Practice Address - Street 1:290 S 4TH ST EXTENSION
Practice Address - Street 2:
Practice Address - City:CONNEAUT LAKE
Practice Address - State:PA
Practice Address - Zip Code:16316
Practice Address - Country:US
Practice Address - Phone:814-382-1133
Practice Address - Fax:814-382-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA280240OtherBLUE CROSS BLUE SHIELD
PA0009844110002Medicaid
59001469Medicare PIN
PA280240Medicare PIN