Provider Demographics
NPI:1457331431
Name:SOUTHBRIDGE EMERGENCY MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:SOUTHBRIDGE EMERGENCY MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-221-5115
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:178 HICKORY GRADE RD
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-0142
Mailing Address - Country:US
Mailing Address - Phone:412-221-5115
Mailing Address - Fax:412-206-0026
Practice Address - Street 1:178 HICKORY GRADE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1240
Practice Address - Country:US
Practice Address - Phone:412-221-5115
Practice Address - Fax:412-206-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA032373416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007708630005Medicaid
PA0007708630004Medicaid
PA590130757OtherRRMC
PA0007708630004Medicaid