Provider Demographics
NPI:1154395028
Name:INGRAM COMMUNITY EMERGENCY AMBULANCE SERVICE, INC
Entity type:Organization
Organization Name:INGRAM COMMUNITY EMERGENCY AMBULANCE SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-921-1449
Mailing Address - Street 1:926 LOCUST ST
Mailing Address - Street 2:C/O MEDICAL BILLING GROUP
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1711
Mailing Address - Country:US
Mailing Address - Phone:412-264-1446
Mailing Address - Fax:412-264-2044
Practice Address - Street 1:40 W. PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205
Practice Address - Country:US
Practice Address - Phone:412-921-1449
Practice Address - Fax:412-921-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031263416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590007595OtherRRMC
PA0014925640001Medicaid
PA590007595OtherRRMC
PA216980OtherBC/BS
PA590007595OtherRRMC