Provider Demographics
NPI:1841200680
Name:ST. MARYS AREA AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:ST. MARYS AREA AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SORG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-781-1571
Mailing Address - Street 1:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-5521
Mailing Address - Country:US
Mailing Address - Phone:800-440-6257
Mailing Address - Fax:724-349-3480
Practice Address - Street 1:773 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-781-1571
Practice Address - Fax:814-781-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA050463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA284836Medicare PIN