=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003880105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | READE AREA AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 05/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 268 READE ST
-----------------------------------------------------
City | BLANDBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-687-3676
-----------------------------------------------------
Fax | 724-887-9440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 514
-----------------------------------------------------
City | BLANDBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16619-0514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-687-3676
-----------------------------------------------------
Fax | 724-887-9440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DENVER AMMERMAN III
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-687-3676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 05146
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------