Provider Demographics
NPI:1972581247
Name:SYKESVILLE AMBULANCE SERVICE
Entity type:Organization
Organization Name:SYKESVILLE AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEHOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-603-1065
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15865-0031
Mailing Address - Country:US
Mailing Address - Phone:814-894-5711
Mailing Address - Fax:814-894-5711
Practice Address - Street 1:215 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:PA
Practice Address - Zip Code:15865-1036
Practice Address - Country:US
Practice Address - Phone:814-894-5711
Practice Address - Fax:814-894-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010639720001Medicaid
PA0433330OtherUNITED MINE WORKERS
590130905Medicare PIN
PA0010639720001Medicaid