Provider Demographics
NPI:1366566465
Name:EAST BRADY AREA AMBULANCE
Entity type:Organization
Organization Name:EAST BRADY AREA AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-526-5065
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:426 KELLYS WAY
Mailing Address - City:EAST BRADY
Mailing Address - State:PA
Mailing Address - Zip Code:16028-0325
Mailing Address - Country:US
Mailing Address - Phone:724-526-5065
Mailing Address - Fax:724-526-3532
Practice Address - Street 1:426 KELLYS WAY
Practice Address - Street 2:
Practice Address - City:EAST BRADY
Practice Address - State:PA
Practice Address - Zip Code:16028-0325
Practice Address - Country:US
Practice Address - Phone:724-526-5065
Practice Address - Fax:724-526-3532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16013341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007936520003Medicaid
PA1038097OtherGATEWAY
PA1038097OtherGATEWAY