MEDICARE: MT. OLIVER AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance		PA

General Provider Information

NPI Number	:	1902092653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT. OLIVER AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	150 BROWNSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-2165
Country	:	US
Telephone Number	:	412-431-8107
Fax Number	:	412-431-0874

Provider Business Practice Location Address
First Line	:	150 BROWNSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-2165
Country	:	US
Telephone Number	:	412-431-8107
Fax Number	:	412-431-0874

Authorized Official
Title or Position	:	ATTORNEY AT LAW
Name	:	JAMES N PERICH
Credential	:
Telephone Number	:	412-391-9331

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/17/2007

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