Organization
COUDERSPORT VOLUNTEER AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BRUNO (PRESIDENT - BOARD OF DIRECTORS)
(814) 274-7411
Entity
Organization
Contact information
Practice address
122 E 2ND ST, COUDERSPORT, PA 16915-1750
(814) 274-7411
(814) 274-9344
Mailing address
PO BOX 651, COUDERSPORT, PA 16915-0651
(814) 274-7411
(814) 274-9344
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
00231
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007005190005
—
PA
01
—
288959
BLUE CROSS/BLUE SHIELD
PA
01
—
590004818
RR MEDICARE/PALMETTO GBA
PA
Enumeration date
01/09/2006
Last updated
04/05/2022
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