Healthcare Provider Details

I. General information

NPI: 1033577259
Provider Name (Legal Business Name): BRADDOCK EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BRADDOCK AVE
BRADDOCK PA
15104-1721
US

IV. Provider business mailing address

126 LINCOLN AVE
NORTH VERSAILLES PA
15137-1855
US

V. Phone/Fax

Practice location:
  • Phone: 412-576-5558
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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:

VIII. Authorized Official

Name: SANDRA L KOLESAR
Title or Position: CEO
Credential: BSW
Phone: 412-576-5558