Provider Demographics
NPI:1720271364
Name:BRADFORD Z STAT AMBULANCE, LLC.
Entity type:Organization
Organization Name:BRADFORD Z STAT AMBULANCE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SCRIVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-598-1392
Mailing Address - Street 1:123 S KENDALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3617
Mailing Address - Country:US
Mailing Address - Phone:814-598-1392
Mailing Address - Fax:814-368-8460
Practice Address - Street 1:123 S KENDALL AVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3617
Practice Address - Country:US
Practice Address - Phone:814-598-1392
Practice Address - Fax:814-368-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA100069992/0003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102039660Medicaid
P00457313OtherRAILROAD MEDICARE
NY02942267Medicaid
PA2030653OtherHIGHMARK BLUE CROSS
PA102039660Medicaid