Provider Demographics
NPI:1740397330
Name:WEST DEER AMBULANCE SERVICE, INC.
Entity type:Organization
Organization Name:WEST DEER AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARIMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLEISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-265-4750
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:RUSSELLTON
Mailing Address - State:PA
Mailing Address - Zip Code:15076
Mailing Address - Country:US
Mailing Address - Phone:724-265-4750
Mailing Address - Fax:724-265-0003
Practice Address - Street 1:101 E UNION RD
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1719
Practice Address - Country:US
Practice Address - Phone:724-265-4750
Practice Address - Fax:724-265-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02137341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011760540002Medicaid