Provider Demographics
NPI:1689684706
Name:MCKEESPORT AMBULANCE AUTHORITY
Entity Type:Organization
Organization Name:MCKEESPORT AMBULANCE AUTHORITY
Other - Org Name:MCKEESPORT AMBULANCE RESCUE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:412-675-5079
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:1604 EVANS AVE
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15134-0580
Mailing Address - Country:US
Mailing Address - Phone:412-675-5076
Mailing Address - Fax:412-675-5072
Practice Address - Street 1:1604 EVANS AVENUE
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132
Practice Address - Country:US
Practice Address - Phone:412-675-5076
Practice Address - Fax:412-675-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
61402OtherUNISON
1003418OtherGATEWAY HP
PA0012427590002Medicaid
1003418OtherGATEWAY HP