Healthcare Provider Details

I. General information

NPI: 1003998824
Provider Name (Legal Business Name): BRENTWOOD EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 BROWNSVILLE RD
PITTSBURGH PA
15227-3153
US

IV. Provider business mailing address

3624 BROWNSVILLE RD
PITTSBURGH PA
15227-3153
US

V. Phone/Fax

Practice location:
  • Phone: 412-884-8740
  • Fax: 412-884-8681
Mailing address:
  • Phone: 412-884-8740
  • Fax: 412-884-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number03125
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number03125
License Number StatePA

VIII. Authorized Official

Name: MR. JOHN NICHOLAS BALKOVEC
Title or Position: OPERATIONS SUPERVISOR
Credential: EMT-P
Phone: 412-884-8740