Organization
BRADFORD Z STAT AMBULANCE, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SALLY LYNN SCRIVO (OFFICE MANAGER)
(814) 598-1392
Entity
Organization
Contact information
Practice address
123 S KENDALL AVE, BRADFORD, PA 16701-3617
(814) 598-1392
(814) 368-8460
Mailing address
123 S KENDALL AVE, BRADFORD, PA 16701-3617
(814) 598-1392
(814) 368-8460
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
100069992/000
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02942267
—
NY
05
—
102039660
—
PA
01
—
2030653
HIGHMARK BLUE CROSS
PA
01
—
P00457313
RAILROAD MEDICARE
—
Enumeration date
08/27/2007
Last updated
12/17/2008
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