Provider Demographics
NPI:1598740003
Name:DUBOISTOWN AMBULANCE SERVICE
Entity Type:Organization
Organization Name:DUBOISTOWN AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CAPTAIN
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:KROPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-321-1189
Mailing Address - Street 1:700 HIGH STREET
Mailing Address - Street 2:C/O WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3109
Mailing Address - Country:US
Mailing Address - Phone:570-321-2003
Mailing Address - Fax:570-321-2263
Practice Address - Street 1:2661 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-6754
Practice Address - Country:US
Practice Address - Phone:570-323-0461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040573416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007672220002Medicaid
PA0007672220002Medicaid
PA0007672220002Medicaid