Active NPI
549 Corporation
- Land Ambulance
- Edwardsville, PA
National Provider Identifier
1609958792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Land Ambulance
- License
- 03367
- Legal business name
- 549 CORPORATION
- Practice address
- 645 Main Street
Edwardsville, PA 18704 - Phone
- (570) 288-5770
- Fax
- (570) 288-0112
- NPI assigned
- Oct 19, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Michael Kowalski
- Title
- President
- Phone
- (570) 288-5770
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Land Ambulance | 3416L0300X | 03367 | PA | Primary |
Addresses
Primary practice location
645 Main Street
Edwardsville, PA 18704
Mailing address
645 Main Street
Edwardsville, PA 18704
Phone (570) 288-5770
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0018250080001 | Other | PA | MEDICAL ASSISTANCE |
| 812825 | Other | PA | BLUE CROSS OF NEPA |
| 0007785194 | Other | PA | AETNA |
| 50036634 | Other | PA | CAPITAL BLUE CROSS |
| P00118710 | Other | PA | RAILROAD MEDICARE |
Other names 1
- Keystone Ambulance Service
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1195603200000",
"number": "1609958792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 MAIN STREET",
"city": "EDWARDSVILLE",
"state": "PA",
"postal_code": "18704",
"telephone_number": "570-288-5770",
"fax_number": "570-288-0112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 MAIN STREET",
"city": "EDWARDSVILLE",
"state": "PA",
"postal_code": "18704",
"telephone_number": "570-288-5770",
"fax_number": "570-288-0112"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "549 CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-19",
"last_updated": "2007-11-21",
"status": "A",
"authorized_official_last_name": "KOWALSKI",
"authorized_official_first_name": "MICHAEL",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "570-288-5770",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "3416L0300X",
"taxonomy_group": "",
"desc": "Ambulance, Land Transport",
"state": "PA",
"license": "03367",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE",
"identifier": "0018250080001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF NEPA",
"identifier": "812825",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007785194",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAPITAL BLUE CROSS",
"identifier": "50036634",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00118710",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Keystone Ambulance Service",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Edwardsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.