Provider Demographics
NPI:1780615971
Name:GEORGES CREEK AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:GEORGES CREEK AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:301-463-2295
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-0155
Mailing Address - Country:US
Mailing Address - Phone:301-463-6122
Mailing Address - Fax:
Practice Address - Street 1:19 UNION ST
Practice Address - Street 2:
Practice Address - City:LONACONING
Practice Address - State:MD
Practice Address - Zip Code:21539-1137
Practice Address - Country:US
Practice Address - Phone:301-463-2295
Practice Address - Fax:410-479-4793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015500400Medicaid
MDY388Medicare PIN
590011166Medicare PIN