Provider Demographics
NPI:1700831401
Name:CENTER FOR EMERGENCY MEDICINE OF WESTERN PENNSYLVANIA
Entity Type:Organization
Organization Name:CENTER FOR EMERGENCY MEDICINE OF WESTERN PENNSYLVANIA
Other - Org Name:STAT MEDEVAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-432-5007
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM 1 - 3RD FLOOR, ROOM 376
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5007
Mailing Address - Fax:412-864-0197
Practice Address - Street 1:10 ALLEGHENY COUNTY AIRPORT
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-2673
Practice Address - Country:US
Practice Address - Phone:412-432-5007
Practice Address - Fax:412-864-0197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03085341600000X, 3416A0800X, 3416L0300X
NY107743416A0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1700831401Medicaid
PA0010996990004Medicaid
VA009020381Medicaid
VT1012088Medicaid
TN4582437Medicaid
KY7100006540Medicaid
NY01872540Medicaid
NH20001746Medicaid
PA590008485OtherPALMETTA GBA MEDICARE
DC0196339 00Medicaid
OH0677996Medicaid
NJ0134147Medicaid
WV0146055000Medicaid
MI184710550Medicaid
KY7100006540Medicaid
VA009020381Medicaid
PA065961Medicare ID - Type UnspecifiedMEDICARE ID #
VT1012088Medicaid
OH9332181Medicare PIN