Provider Demographics
NPI:1679564850
Name:HUNTINGDON AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:HUNTINGDON AMBULANCE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-643-6551
Mailing Address - Street 1:PO BOX 16
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-0016
Mailing Address - Country:US
Mailing Address - Phone:814-643-6551
Mailing Address - Fax:814-643-2644
Practice Address - Street 1:411 10TH STREET
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-0000
Practice Address - Country:US
Practice Address - Phone:814-643-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0036315000OtherKEYSTONE HP EAST COMM.
PA248541OtherBCBS OF PA BLUE SHIELD
PA0019206330006Medicaid
0036315000OtherKEYSTONE HP EAST HMO MDC
590015316OtherUNITED HC RR MEDICARE
590015316OtherUNITED HC RR MEDICARE
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=========OtherTRI CARE NORTHEAST
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