Provider Demographics
NPI:1184616492
Name:CRESSON AREA AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:CRESSON AREA AMBULANCE SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKENRODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-886-5641
Mailing Address - Street 1:PO BOX 6321
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0924
Mailing Address - Country:US
Mailing Address - Phone:814-886-5641
Mailing Address - Fax:724-234-4703
Practice Address - Street 1:725 2ND ST
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1139
Practice Address - Country:US
Practice Address - Phone:814-886-5641
Practice Address - Fax:814-886-7514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA030253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
1374208OtherUMWA FUNDS
590004314OtherRR MEDICARE
PA0009645080003Medicaid