=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407834203
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEDFORD AREA AMBULANCE SERVICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 W VONDERSMITH AVE
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15522-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-623-6534
-----------------------------------------------------
Fax | 814-623-0648
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 625 130 W. VONDERSMITH AVE.
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15522-1727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-623-6534
-----------------------------------------------------
Fax | 814-623-0648
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | HEATHER BEEGLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-623-6534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 03303
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------