Provider Demographics
NPI:1659484285
Name:CAMERON COUNTY AMBULANCE SERVICE INC.
Entity Type:Organization
Organization Name:CAMERON COUNTY AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WENNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-486-0260
Mailing Address - Street 1:299 EAST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1339
Mailing Address - Country:US
Mailing Address - Phone:814-486-0260
Mailing Address - Fax:814-486-3455
Practice Address - Street 1:299 EAST 2ND STREET
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1339
Practice Address - Country:US
Practice Address - Phone:814-486-0260
Practice Address - Fax:814-486-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03124341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000717418Medicaid