MEDICARE: CONESTOGA AMBULANCE ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	04241	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710961289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONESTOGA AMBULANCE ASSOCIATION

Provider Business Mailing Address
First Line	:	PO BOX 329
Second Line	:
City	:	WILLOW STREET
State	:	PA
Zip	:	17584-0329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3292 MAIN ST
Second Line	:
City	:	CONESTOGA
State	:	PA
Zip	:	17516-9702
Country	:	US
Telephone Number	:	717-464-0724
Fax Number	:

Authorized Official
Title or Position	:	BILLING
Name	:	DANIEL C ROTH
Credential	:
Telephone Number	:	717-464-0724

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	08/22/2020

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