Provider Demographics
NPI:1952436503
Name:PORTAGE AREA AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:PORTAGE AREA AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIMINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-241-9663
Mailing Address - Street 1:P O BOX 237
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-0237
Mailing Address - Country:US
Mailing Address - Phone:800-280-5974
Mailing Address - Fax:724-794-1633
Practice Address - Street 1:655 NORTH RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:PA
Practice Address - Zip Code:15946-0237
Practice Address - Country:US
Practice Address - Phone:814-241-9663
Practice Address - Fax:724-794-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA051143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001609595 0003Medicaid
PA286922Medicare ID - Type UnspecifiedMEDICARE
PA590409143Medicare ID - Type UnspecifiedRAILROADER'S MEDICARE