Provider Demographics
NPI:1922421965
Name:TRI-COUNTRY AMBULANCE
Entity Type:Organization
Organization Name:TRI-COUNTRY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GRABOUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-955-8409
Mailing Address - Street 1:352 SCRANTON POCONO HWY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7900
Mailing Address - Country:US
Mailing Address - Phone:570-955-8409
Mailing Address - Fax:
Practice Address - Street 1:352 SCRANTON POCONO HWY
Practice Address - Street 2:
Practice Address - City:COVINGTON TWP
Practice Address - State:PA
Practice Address - Zip Code:18444-7900
Practice Address - Country:US
Practice Address - Phone:570-955-8409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0000003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport