Provider Demographics
NPI:1841383833
Name:EUREKA COMMUNITY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:EUREKA COMMUNITY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKRUIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-468-1212
Mailing Address - Street 1:304 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1806
Mailing Address - Country:US
Mailing Address - Phone:724-224-1499
Mailing Address - Fax:724-468-1204
Practice Address - Street 1:304 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084-1806
Practice Address - Country:US
Practice Address - Phone:724-224-1499
Practice Address - Fax:724-468-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060893416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008956700001Medicaid
PA0008956700001Medicaid