Provider Demographics
NPI:1831284827
Name:QUICK RESPONSE SERVICE MEDICAL TRAN
Entity Type:Organization
Organization Name:QUICK RESPONSE SERVICE MEDICAL TRAN
Other - Org Name:QRS MEDICAL TRANSPORT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-924-4795
Mailing Address - Street 1:41 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2911
Mailing Address - Country:US
Mailing Address - Phone:215-368-7350
Mailing Address - Fax:215-368-7353
Practice Address - Street 1:41 E FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2911
Practice Address - Country:US
Practice Address - Phone:215-368-7350
Practice Address - Fax:215-368-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA06127341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018131620001Medicaid
PAP00354512OtherRR MEDICARE
PAP00354512OtherRR MEDICARE