Healthcare Provider Details

I. General information

NPI: 1033289715
Provider Name (Legal Business Name): FREEPORT EMERGENCY MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MARKET ST
FREEPORT PA
16229-1122
US

IV. Provider business mailing address

PO BOX 158 400 MARKET ST
FREEPORT PA
16229-0158
US

V. Phone/Fax

Practice location:
  • Phone: 724-295-2300
  • Fax: 724-295-2970
Mailing address:
  • Phone: 724-295-2980
  • Fax: 724-295-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number013169
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier285818
Identifier TypeOTHER
Identifier State
Identifier IssuerHIGHMARK
# 2
Identifier80049
Identifier TypeOTHER
Identifier State
Identifier IssuerBLACK LUNG
# 3
Identifier95604
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier0009601420001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier35696
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTH AMERICA
# 6
Identifier7258007
Identifier TypeOTHER
Identifier State
Identifier IssuerAETNA US HEALTHCARE
# 7
Identifier1529059
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 8
Identifier463672
Identifier TypeOTHER
Identifier State
Identifier IssuerCOMBINED INS. CO OF AMER
# 9
IdentifierV0V097
Identifier TypeOTHER
Identifier State
Identifier IssuerUPMC

VIII. Authorized Official

Name: DAVID RENNICK
Title or Position: OPERATIONS SUPERVISOR
Credential:
Phone: 724-295-2980