Provider Demographics
NPI:1679596563
Name:PENNSYLVANIA MEDICAL TRANSPORT, INC.
Entity type:Organization
Organization Name:PENNSYLVANIA MEDICAL TRANSPORT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HELTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-752-1413
Mailing Address - Street 1:332 WAMPUM AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1269
Mailing Address - Country:US
Mailing Address - Phone:724-752-1413
Mailing Address - Fax:724-752-1402
Practice Address - Street 1:332 WAMPUM AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1269
Practice Address - Country:US
Practice Address - Phone:724-752-1413
Practice Address - Fax:724-752-1402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA060393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012532420004Medicaid
PA1500578Medicaid
PAP020314OtherCHAMPA/CHAMPUS
PA201100OtherUPMC HEALTH PLAN
PA0120225OtherAETNA
PA201100OtherUPMC HEALTH PLAN