Provider Demographics
NPI:1710916556
Name:RAYSTOWN AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:RAYSTOWN AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-652-6018
Mailing Address - Street 1:892 NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-4228
Mailing Address - Country:US
Mailing Address - Phone:800-280-5974
Mailing Address - Fax:724-234-4703
Practice Address - Street 1:4 E SOUTH STREET
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1222
Practice Address - Country:US
Practice Address - Phone:814-652-5822
Practice Address - Fax:724-794-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03228341600000X
3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007191090001Medicaid
PA590409135OtherUNITED HEALTHCARE RAILROA
PA590409135OtherUNITED HEALTHCARE RAILROA