Provider Demographics
NPI:1669463931
Name:DUBOIS EMERGENCY MEDICAL SERVICES AMBULANCE
Entity Type:Organization
Organization Name:DUBOIS EMERGENCY MEDICAL SERVICES AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-375-1185
Mailing Address - Street 1:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0333
Mailing Address - Country:US
Mailing Address - Phone:814-375-1185
Mailing Address - Fax:814-375-4303
Practice Address - Street 1:103 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2006
Practice Address - Country:US
Practice Address - Phone:814-375-1185
Practice Address - Fax:814-375-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1342045OtherUNITED MINE WORKERS
PA0010314870002Medicaid
PA1342045OtherUNITED MINE WORKERS
59003105Medicare PIN