Provider Demographics
NPI:1780669960
Name:CITY OF BRADFORD
Entity Type:Organization
Organization Name:CITY OF BRADFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-362-3887
Mailing Address - Street 1:24 KENNEDY ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2006
Mailing Address - Country:US
Mailing Address - Phone:814-362-3887
Mailing Address - Fax:814-368-3335
Practice Address - Street 1:24 KENNEDY ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-6508
Practice Address - Country:US
Practice Address - Phone:814-362-3887
Practice Address - Fax:814-368-3335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-12
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA040553416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590004092OtherAMBULANCE SERVICE
PA001085817Medicaid
NY01404324Medicaid
PA001085817Medicaid