Provider Demographics
NPI:1497012280
Name:SOUTHERN BUREAU OF EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:SOUTHERN BUREAU OF EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:724-561-8838
Mailing Address - Street 1:660 RED DOG ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15043-1056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 RED DOG ROAD EXT
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:PA
Practice Address - Zip Code:15043-1056
Practice Address - Country:US
Practice Address - Phone:724-462-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport