Provider Demographics
NPI:1730151200
Name:FAYETTE TOWNSHIP E.M.S., INC.
Entity type:Organization
Organization Name:FAYETTE TOWNSHIP E.M.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:KERSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-235-2042
Mailing Address - Street 1:P.O. BOX 98
Mailing Address - Street 2:3 CEDAR COURT
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-0098
Mailing Address - Country:US
Mailing Address - Phone:717-728-9223
Mailing Address - Fax:717-728-9344
Practice Address - Street 1:18 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCALISTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:17049-0032
Practice Address - Country:US
Practice Address - Phone:717-463-9888
Practice Address - Fax:717-463-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04135341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016828360001Medicaid
PA240922Medicare ID - Type Unspecified