Provider Demographics
NPI:1598786931
Name:MEADVILLE AREA AMBULANCE SERVICE LLC
Entity Type:Organization
Organization Name:MEADVILLE AREA AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:S
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-724-7598
Mailing Address - Street 1:872 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3455
Mailing Address - Country:US
Mailing Address - Phone:814-724-7598
Mailing Address - Fax:814-337-1153
Practice Address - Street 1:872 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3455
Practice Address - Country:US
Practice Address - Phone:814-724-7598
Practice Address - Fax:814-337-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010125550001Medicaid
PA241887OtherHEALTH AMERICA
PA001629049OtherHIGHMARK BLUE SHIELD
PA1010125550001OtherION HEALTH
PA606018100OtherFEDERAL BLACK LUNG PROGRAM
PA2305927000OtherINDEPENDENCE BLUE
PA606018100OtherDEPARTMENT OF LABOR
PA606018100OtherDEPARTMENT OF LABOR
PA241887OtherHEALTH AMERICA