Organization
CANONSBURG GENERAL HOSPITAL AMBULANCE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY M WILTROUT (DIRECTOR OF OPERATIONS)
(724) 873-5880
Entity
Organization
Contact information
Practice address
209 W PIKE ST, CANONSBURG, PA 15317-1143
(724) 745-6911
(724) 745-8919
Mailing address
PO BOX 207, ALLENTOWN, PA 18105-0207
(484) 664-2007
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
04005
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016844380002
—
PA
01
—
1004559
AETNA USHC BLUE BELL HMO
—
01
—
103520
UPMC HEALTH PLAM COMM
—
01
—
1502794
GATEWAY HLTH PLAN HMO DPA
—
01
—
1529544
UMWA HEALTH RETIREMENT
—
01
—
241796
BCBS OF PA BLUE SHIELD
PA
01
—
590012280
UNITED HC RR MEDICARE
—
Enumeration date
01/10/2006
Last updated
11/18/2011
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