Healthcare Provider Details

I. General information

NPI: 1679132856
Provider Name (Legal Business Name): REGIONAL EMERGENCY SUPPORT QUICK RESPONSE SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 STATE ROUTE 168
GEORGETOWN PA
15043
US

IV. Provider business mailing address

PO BOX 18533
PITTSBURGH PA
15236-0533
US

V. Phone/Fax

Practice location:
  • Phone: 124-859-7377
  • Fax: 724-234-4703
Mailing address:
  • Phone: 800-240-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1036714040001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: RYAN COBERN
Title or Position: OWNER
Credential:
Phone: 412-859-7377