Provider Demographics
NPI:1144297375
Name:GOLD CROSS AMBULANCE SERVICES OF PA, INC
Entity type:Organization
Organization Name:GOLD CROSS AMBULANCE SERVICES OF PA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:STREETY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-882-8400
Mailing Address - Street 1:481 WILLIAM GAITER PKWY
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2731
Mailing Address - Country:US
Mailing Address - Phone:716-882-8400
Mailing Address - Fax:716-887-8379
Practice Address - Street 1:3625 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3411
Practice Address - Country:US
Practice Address - Phone:724-981-2534
Practice Address - Fax:724-981-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA043143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000209473OtherHIGHMARK
PA000000226426OtherANTHEM
PA1007595730002Medicaid
PA1007595730002Medicaid
PA1007595730002Medicaid