Provider Demographics
NPI:1265417067
Name:CRANBERRY TOWNSHIP EMERGENCY MEDICAL SERVICE
Entity type:Organization
Organization Name:CRANBERRY TOWNSHIP EMERGENCY MEDICAL SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-776-4380
Mailing Address - Street 1:802 THOMSON PARK DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6428
Mailing Address - Country:US
Mailing Address - Phone:724-776-4380
Mailing Address - Fax:724-779-1040
Practice Address - Street 1:802 THOMSON PARK DR
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6428
Practice Address - Country:US
Practice Address - Phone:724-776-4380
Practice Address - Fax:724-779-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02188146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010590300001Medicaid