Provider Demographics
NPI:1013991389
Name:WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Entity Type:Organization
Organization Name:WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Other - Org Name:SUSQUEHANNA REGIONAL EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-321-3171
Mailing Address - Street 1:777 RURAL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3109
Mailing Address - Country:US
Mailing Address - Phone:570-321-2003
Mailing Address - Fax:570-321-2263
Practice Address - Street 1:777 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3109
Practice Address - Country:US
Practice Address - Phone:570-321-2003
Practice Address - Fax:570-321-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010733240001Medicaid
PA069905OtherFIRST PRIORITY HEALTH HMO
PA069905OtherFIRST PRIORITY HEALTH HMO
590003511Medicare ID - Type UnspecifiedRAILROAD MEDICARE
PA0010733240001Medicaid