Provider Demographics
NPI:1942283965
Name:EAST BRADY AREA AMB SERVICE
Entity Type:Organization
Organization Name:EAST BRADY AREA AMB SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-526-5065
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:426 KELLYS WAY
Mailing Address - City:EAST BRADY
Mailing Address - State:PA
Mailing Address - Zip Code:16028-0325
Mailing Address - Country:US
Mailing Address - Phone:724-526-5065
Mailing Address - Fax:724-526-3532
Practice Address - Street 1:426 KELLYS WAY
Practice Address - Street 2:
Practice Address - City:EAST BRADY
Practice Address - State:PA
Practice Address - Zip Code:16028-0325
Practice Address - Country:US
Practice Address - Phone:724-526-5065
Practice Address - Fax:724-526-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA146L00000X, 146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007936520004Medicaid
PA284527Medicare ID - Type Unspecified