Provider Demographics
NPI:1194707992
Name:RIDGWAY AMBULANCE CORPORATION
Entity type:Organization
Organization Name:RIDGWAY AMBULANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MARNATTI
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-PARAMEDIC
Authorized Official - Phone:814-773-3633
Mailing Address - Street 1:301 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-2103
Mailing Address - Country:US
Mailing Address - Phone:814-773-3633
Mailing Address - Fax:814-772-1001
Practice Address - Street 1:301 N BROAD ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-2103
Practice Address - Country:US
Practice Address - Phone:814-773-3633
Practice Address - Fax:814-772-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03347341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590420110OtherRR MEDICARE
PA0447765OtherUMWA
PA0006999550001Medicaid
PA0447765OtherUMWA