Organization
549 CORPORATION
Active
Other names
Keystone Ambulance Service
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL KOWALSKI (PRESIDENT)
(570) 288-5770
Entity
Organization
Contact information
Practice address
645 MAIN STREET, EDWARDSVILLE, PA 18704
(570) 288-5770
(570) 288-0112
Mailing address
645 MAIN STREET, EDWARDSVILLE, PA 18704
(570) 288-5770
(570) 288-0112
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
03367
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007785194
AETNA
PA
01
—
0018250080001
MEDICAL ASSISTANCE
PA
01
—
50036634
CAPITAL BLUE CROSS
PA
01
—
812825
BLUE CROSS OF NEPA
PA
01
—
P00118710
RAILROAD MEDICARE
PA
Enumeration date
10/19/2006
Last updated
11/21/2007
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