MEDICARE: PORTAGE AREA 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	05114	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	:	1952436503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTAGE AREA AMBULANCE ASSOCIATION

Provider Business Mailing Address
First Line	:	P O BOX 237
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-0237
Country	:	US
Telephone Number	:	800-280-5974
Fax Number	:	724-794-1633

Provider Business Practice Location Address
First Line	:	655 NORTH RAILROAD AVE
Second Line	:
City	:	PORTAGE
State	:	PA
Zip	:	15946-0237
Country	:	US
Telephone Number	:	814-241-9663
Fax Number	:	724-794-1633

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MR. CHARLES RIMINI
Credential	:
Telephone Number	:	814-241-9663

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/17/2020

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