Provider Demographics
NPI:1447256904
Name:PRESTIGE MANAGEMENT SERVICE CORP
Entity type:Organization
Organization Name:PRESTIGE MANAGEMENT SERVICE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUGHMANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-774-6990
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-0269
Mailing Address - Country:US
Mailing Address - Phone:724-774-6990
Mailing Address - Fax:724-774-6969
Practice Address - Street 1:638 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1643
Practice Address - Country:US
Practice Address - Phone:724-774-6990
Practice Address - Fax:724-774-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02172341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008874OtherGATEWAY HEALTH PLAN
PA0012293180002Medicaid
PA212990Medicare ID - Type UnspecifiedMEDICARE