Provider Demographics
NPI:1336204577
Name:PRIORITY CARE AMBULANCE
Entity Type:Organization
Organization Name:PRIORITY CARE AMBULANCE
Other - Org Name:PRIORITY CARE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-887-1982
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-0344
Mailing Address - Country:US
Mailing Address - Phone:814-887-1982
Mailing Address - Fax:
Practice Address - Street 1:113 WEST WATER STREET
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749
Practice Address - Country:US
Practice Address - Phone:814-887-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04097341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA236942Medicare ID - Type Unspecified