Provider Demographics
NPI:1508077447
Name:PORT AREA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:PORT AREA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-642-2057
Mailing Address - Street 1:22279 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEGANY
Mailing Address - State:PA
Mailing Address - Zip Code:16743-1617
Mailing Address - Country:US
Mailing Address - Phone:814-642-2057
Mailing Address - Fax:814-642-2912
Practice Address - Street 1:22279 ROUTE 6
Practice Address - Street 2:
Practice Address - City:PORT ALLEGANY
Practice Address - State:PA
Practice Address - Zip Code:16743-1617
Practice Address - Country:US
Practice Address - Phone:814-642-2057
Practice Address - Fax:814-642-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04289341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590006536Medicaid
PA289056Medicare ID - Type Unspecified