Healthcare Provider Details

I. General information

NPI: 1336701358
Provider Name (Legal Business Name): TRI STATE EMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1391 EASTON RD
ABINGTON PA
19001-2453
US

IV. Provider business mailing address

PO BOX 18533
PITTSBURGH PA
15236-0533
US

V. Phone/Fax

Practice location:
  • Phone: 610-504-5464
  • Fax: 610-549-7449
Mailing address:
  • Phone: 610-246-6908
  • Fax: 724-234-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1037289730001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: ALEXANDER ORION KVETAN
Title or Position: ADMINISTRATION
Credential:
Phone: 610-504-5464