Provider Demographics
NPI:1336701358
Name:TRI STATE EMS LLC
Entity type:Organization
Organization Name:TRI STATE EMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:ORION
Authorized Official - Last Name:KVETAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-504-5464
Mailing Address - Street 1:PO BOX 18533
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-0533
Mailing Address - Country:US
Mailing Address - Phone:610-246-6908
Mailing Address - Fax:724-234-4703
Practice Address - Street 1:1391 EASTON RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2453
Practice Address - Country:US
Practice Address - Phone:610-504-5464
Practice Address - Fax:610-549-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037289730001Medicaid