Provider Demographics
NPI:1437123007
Name:THE CRESCENT HOSE COMPANY
Entity type:Organization
Organization Name:THE CRESCENT HOSE COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIORAZIO
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:814-725-1047
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-0089
Mailing Address - Country:US
Mailing Address - Phone:814-725-1047
Mailing Address - Fax:814-725-2603
Practice Address - Street 1:36 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1341
Practice Address - Country:US
Practice Address - Phone:814-725-1047
Practice Address - Fax:814-725-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA286459OtherBLUE CROSS/BLUE SHIELD
PA345104OtherHEALTH AMERICA
PA103047504001Medicaid
PA219622OtherUPMC HEALTH PLAN
PA590015490OtherPALMETTO GBA
PA590015490OtherRR MEDICARE/PALMETTO GBA
PA=========OtherTRICARE
PA073312Medicare PIN