Provider Demographics
NPI:1174539977
Name:TRI TOWN AMBULANCE ASSOCIATION
Entity type:Organization
Organization Name:TRI TOWN AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:O
Authorized Official - Last Name:ERWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-848-7565
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:PA
Mailing Address - Zip Code:16948-0247
Mailing Address - Country:US
Mailing Address - Phone:814-848-7565
Mailing Address - Fax:
Practice Address - Street 1:810 STATE ROUTE 49 WEST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:PA
Practice Address - Zip Code:16948
Practice Address - Country:US
Practice Address - Phone:814-848-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060523416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011305400001Medicaid
PA1011305400001Medicaid