Provider Demographics
NPI:1669450334
Name:EBENSBURG AREA AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:EBENSBURG AREA AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:NRP,CCEMTP
Authorized Official - Phone:814-472-6700
Mailing Address - Street 1:800 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1804
Mailing Address - Country:US
Mailing Address - Phone:814-472-6700
Mailing Address - Fax:814-472-9583
Practice Address - Street 1:800 W HIGH ST
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-1804
Practice Address - Country:US
Practice Address - Phone:814-472-6700
Practice Address - Fax:814-472-9583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060963416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010086670003Medicaid
PA0010086670002Medicaid
PA0010086670002Medicaid