Provider Demographics
NPI:1104825991
Name:MEDIC 9 PARAMEDIC SERVICE, INC.
Entity type:Organization
Organization Name:MEDIC 9 PARAMEDIC SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DEREAMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-588-9816
Mailing Address - Street 1:311 BLUE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1528
Mailing Address - Country:US
Mailing Address - Phone:610-588-9816
Mailing Address - Fax:610-588-9818
Practice Address - Street 1:311 BLUE VALLEY DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1528
Practice Address - Country:US
Practice Address - Phone:610-588-9816
Practice Address - Fax:610-588-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
PA022753416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Not Answered3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011898940002Medicaid
214061Medicare ID - Type Unspecified