Provider Demographics
NPI:1316948292
Name:WILLIAMSPORT AND DEERCREEK EMERGENCY SQUAD
Entity type:Organization
Organization Name:WILLIAMSPORT AND DEERCREEK EMERGENCY SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-986-3651
Mailing Address - Street 1:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-0727
Mailing Address - Country:US
Mailing Address - Phone:440-605-9117
Mailing Address - Fax:440-442-4443
Practice Address - Street 1:107 GREEN STREET
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:OH
Practice Address - Zip Code:43164-9800
Practice Address - Country:US
Practice Address - Phone:440-605-9117
Practice Address - Fax:440-442-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000379087OtherANTHEM
OH2611276Medicaid
OHP00237229OtherRAILROAD MEDICARE
OH9355891Medicare UPIN