Healthcare Provider Details

I. General information

NPI: 1316949878
Provider Name (Legal Business Name): CORRY AMBULANCE SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 SHAMROCK LN
CORRY PA
16407-9121
US

IV. Provider business mailing address

1926 PEACH ST
ERIE PA
16502-2872
US

V. Phone/Fax

Practice location:
  • Phone: 814-664-8656
  • Fax: 814-870-1950
Mailing address:
  • Phone: 814-870-1010
  • Fax: 814-870-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number05045
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05045
License Number StatePA

VIII. Authorized Official

Name: ABIGAIL JOHNSON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 814-870-1032