Provider Demographics
NPI:1548394786
Name:ENDEAVOR EMERGENCY SQUAD, INC
Entity Type:Organization
Organization Name:ENDEAVOR EMERGENCY SQUAD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:EKELBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-386-8899
Mailing Address - Street 1:892 NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-4228
Mailing Address - Country:US
Mailing Address - Phone:800-280-5974
Mailing Address - Fax:724-234-4703
Practice Address - Street 1:1309 RANCOCAS RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3701
Practice Address - Country:US
Practice Address - Phone:609-386-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1078331OtherHORIZON NJ HEALTH
NJ7687109Medicaid
NJ0720376000OtherKEYSTONE
NJ0720376000OtherAMERIHEALTH
NJ90000624800OtherAMERICHOICE
NJ0720376000OtherKEYSTONE