Healthcare Provider Details

I. General information

NPI: 1649277617
Provider Name (Legal Business Name): TRANS AM AMBULANCE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N 8TH ST
OLEAN NY
14760-9549
US

IV. Provider business mailing address

PO BOX 660886
DALLAS TX
75266-0886
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-5871
  • Fax: 716-372-1856
Mailing address:
  • Phone: 716-372-5871
  • Fax: 716-372-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number32310
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number10251
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000586002001
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUE CROSS BLUE SHIELD WN
# 2
Identifier8190081
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDEPENDENT HEALTH
# 3
Identifier00931580
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 4
Identifier1011821430001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier00011213801
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUNIVERA

VIII. Authorized Official

Name: ROBERT A JEWELL
Title or Position: CHIEF REVENUE INTEGRATION OFFICER
Credential:
Phone: 844-597-4911