Provider Demographics
NPI:1669446779
Name:SHINGLEHOUSE AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:SHINGLEHOUSE AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SALADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-697-6129
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:130 S MILL ST
Practice Address - Street 2:
Practice Address - City:SHINGLEHOUSE
Practice Address - State:PA
Practice Address - Zip Code:16748-1675
Practice Address - Country:US
Practice Address - Phone:814-697-6129
Practice Address - Fax:814-697-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010333416L0300X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000764338-0005Medicaid
PA284901OtherBLUE CROSS/BLUE SHIELD
PA590012010OtherRR MEDICARE/PALMETTO GBA
PA284901OtherBLUE CROSS/BLUE SHIELD
PA0007643380003Medicaid