Provider Demographics
NPI:1720195738
Name:JEFFERSON COUNTY EMS INC
Entity Type:Organization
Organization Name:JEFFERSON COUNTY EMS INC
Other - Org Name:JEFFERSON COUNTY EMS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-938-0271
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:501 PINE ST
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-0014
Mailing Address - Country:US
Mailing Address - Phone:814-938-4119
Mailing Address - Fax:814-938-3527
Practice Address - Street 1:501 PINE ST
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-0014
Practice Address - Country:US
Practice Address - Phone:814-938-4119
Practice Address - Fax:814-938-3527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA052143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007006530003Medicaid
PA280498Medicare UPIN
PA280498Medicare ID - Type UnspecifiedAMBULANCE