Healthcare Provider Details

I. General information

NPI: 1689684706
Provider Name (Legal Business Name): MCKEESPORT AMBULANCE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 EVANS AVENUE
MCKEESPORT PA
15132
US

IV. Provider business mailing address

PO BOX 580 1604 EVANS AVE
MCKEESPORT PA
15134-0580
US

V. Phone/Fax

Practice location:
  • Phone: 412-675-5076
  • Fax: 412-675-5072
Mailing address:
  • Phone: 412-675-5076
  • Fax: 412-675-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05163
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier61402
Identifier TypeOTHER
Identifier State
Identifier IssuerUNISON
# 2
Identifier1003418
Identifier TypeOTHER
Identifier State
Identifier IssuerGATEWAY HP
# 3
Identifier0012427590002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. WILLIAM RICHARD MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential: EMTP
Phone: 412-675-5079