Provider Demographics
NPI:1770521916
Name:PRIORITY ONE MEDICAL TRANSPORT, INC.
Entity type:Organization
Organization Name:PRIORITY ONE MEDICAL TRANSPORT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KOLESAR-PEPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT PARAMEDIC, BSW
Authorized Official - Phone:412-823-4980
Mailing Address - Street 1:1119 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:EAST MC KEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15035-1517
Mailing Address - Country:US
Mailing Address - Phone:412-823-4980
Mailing Address - Fax:412-823-4917
Practice Address - Street 1:1119 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EAST MC KEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15035-1517
Practice Address - Country:US
Practice Address - Phone:412-823-4980
Practice Address - Fax:412-823-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031273416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
239347OtherBC
PA1007683580004Medicaid
PA029745OtherMEDICARE
PA239347OtherHIGHMARK BLUE CROSS
590013955OtherRR MEDICAR
PW100742629003Medicaid
PA1007683580006Medicaid
1504971OtherGATEWAY
252545OtherUPMC
PA029745OtherMEDICARE