NPIMap

Organization Active NPI

Williamsport Area Ambulance Service Cooperative

Doing business as Susquehanna Regional EMS

  • Land Ambulance
  • Williamsport, PA
National Provider Identifier
1013991389
Registry record updated May 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
05116 Issued in PA
Legal business name
WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE
Doing business as
Susquehanna Regional EMS
Practice address
777 Rural Ave
Williamsport, PA 17701-3109
Phone
(570) 321-2003
Fax
(570) 321-2263
NPI assigned
Dec 1, 2005
Last updated
May 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Charles Santangelo
Title
Executive VP/Cfo
Phone
(570) 321-3171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 05116 PA Primary

Addresses

Primary practice location

777 Rural Ave
Williamsport, PA 17701-3109

Mailing address

777 Rural Ave
Williamsport, PA 17701-3109
Phone (570) 321-2003

Other identifiers 2

IdentifierTypeStateIssuer
0010733240001MedicaidPA
069905OtherPAFIRST PRIORITY HEALTH HMO

Other names 1

  • Susquehanna Regional EMS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080211000690 PA Part B Supplier - Ambulance Service Supplier 7214923325 Practice locations: Coudersport, PA; Montoursville, PA; Muncy, PA; South Williamsport, PA; Wellsboro, PA; Williamsport, PA

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

Locations

820 Broad St
Montoursville, PA 17754
Phone (570) 321-2003

1145 Almond St
Williamsport, PA 17701
Phone (570) 321-2003

573 Hastings St
Williamsport, PA 17702
Phone (570) 321-2003

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210032000000",
    "number": "1013991389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 RURAL AVE",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013109",
            "telephone_number": "570-321-2003",
            "fax_number": "570-321-2263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 RURAL AVE",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "177013109",
            "telephone_number": "570-321-2003",
            "fax_number": "570-321-2263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSPORT AREA AMBULANCE SERVICE COOPERATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-01",
        "last_updated": "2008-05-06",
        "status": "A",
        "authorized_official_last_name": "SANTANGELO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "EXECUTIVE VP/CFO",
        "authorized_official_telephone_number": "570-321-3171",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "PA",
            "license": "05116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010733240001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PRIORITY HEALTH HMO",
            "identifier": "069905",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susquehanna Regional EMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.