Provider Demographics
NPI:1316547011
Name:MILLS, DAVID RILEY (EMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RILEY
Last Name:MILLS
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1161
Mailing Address - Country:US
Mailing Address - Phone:267-819-5620
Mailing Address - Fax:
Practice Address - Street 1:6 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-1161
Practice Address - Country:US
Practice Address - Phone:267-819-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA112127146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic