Provider Demographics
NPI:1518938042
Name:PORT ROYAL EMERGENCY MEDICAL SERVICES INC.
Entity Type:Organization
Organization Name:PORT ROYAL EMERGENCY MEDICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:NIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-527-2932
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:PA
Mailing Address - Zip Code:17082
Mailing Address - Country:US
Mailing Address - Phone:717-527-2932
Mailing Address - Fax:717-527-4283
Practice Address - Street 1:212 WEST FOURTH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT ROYAL
Practice Address - State:PA
Practice Address - Zip Code:17082
Practice Address - Country:US
Practice Address - Phone:717-527-2932
Practice Address - Fax:717-527-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05040341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018656760004Medicaid
PA046692Medicare PIN