Provider Demographics
NPI:1720043284
Name:CONEMAUGH VALLEY REGIONAL AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:CONEMAUGH VALLEY REGIONAL AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:RYKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-659-6555
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:814-535-5300
Practice Address - Street 1:1125 MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-2016
Practice Address - Country:US
Practice Address - Phone:814-535-5300
Practice Address - Fax:724-234-4703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051403416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080042700OtherFED BLACK LUNG
PA590015282OtherRAILROAD MEDICARE
PA1401311OtherHIGHMARK
PA0019174400001Medicaid