Provider Demographics
NPI:1811066186
Name:LOWER KISKI AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:LOWER KISKI AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-845-8504
Mailing Address - Street 1:80 KISKI AVE
Mailing Address - Street 2:PO BOX 397
Mailing Address - City:LEECHBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15656-0397
Mailing Address - Country:US
Mailing Address - Phone:724-845-8504
Mailing Address - Fax:724-845-8237
Practice Address - Street 1:80 KISKI AVENUE
Practice Address - Street 2:
Practice Address - City:LEECHBURG
Practice Address - State:PA
Practice Address - Zip Code:15656-0397
Practice Address - Country:US
Practice Address - Phone:724-845-8504
Practice Address - Fax:724-845-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA052233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008381Medicaid
6606OtherHEALTHAMERICA
286034OtherHIGHMARK
05794093OtherAETNA US HEALTHCARE
PA0007657920002Medicaid
C36299OtherHUMA CLAIMS OFFICE
V0V20XOtherUPMC
2015876OtherOHIO CASUALTY GROUP
590130790Medicare ID - Type UnspecifiedPALMETTO GBA RAILROAD MED
PA286034Medicare ID - Type Unspecified
PA0007657920002Medicaid