Healthcare Provider Details

I. General information

NPI: 1750457214
Provider Name (Legal Business Name): BOROUGH OF JEFFERSON AMBULANCE ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 CENTURY DRIVE
JEFFERSON HILLS PA
15025
US

IV. Provider business mailing address

2121 CENTURY DRIVE
JEFFERSON HILLS PA
15025
US

V. Phone/Fax

Practice location:
  • Phone: 412-384-0111
  • Fax: 412-384-0117
Mailing address:
  • Phone: 412-384-0111
  • Fax: 412-384-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number02267
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DOUGLAS PASCOE
Title or Position: DIRECTOR CHIEF
Credential:
Phone: 412-384-0111