Provider Demographics
NPI:1902925860
Name:BENTWORTH AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:BENTWORTH AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAHALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-239-5512
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:6 DIAMOND WAY
Mailing Address - City:BENTLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15314-0152
Mailing Address - Country:US
Mailing Address - Phone:724-239-5521
Mailing Address - Fax:
Practice Address - Street 1:6 DIAMOND WAY
Practice Address - Street 2:
Practice Address - City:BENTLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15314-1997
Practice Address - Country:US
Practice Address - Phone:724-239-5521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA06038146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA284579Medicare ID - Type UnspecifiedAMBULANCE