Provider Demographics
NPI:1528044690
Name:NON PROFIT EMERGENCY SERVICES OF BEAVER COUNTY
Entity Type:Organization
Organization Name:NON PROFIT EMERGENCY SERVICES OF BEAVER COUNTY
Other - Org Name:MEDIC RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-728-3621
Mailing Address - Street 1:313 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2906
Mailing Address - Country:US
Mailing Address - Phone:724-728-3621
Mailing Address - Fax:724-728-3696
Practice Address - Street 1:313 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2906
Practice Address - Country:US
Practice Address - Phone:724-728-3621
Practice Address - Fax:724-728-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050923416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009131150004Medicaid
PA0009131150004Medicaid