Provider Demographics
NPI:1558029165
Name:PROFESSIONAL MEDICAL RESPONSE, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL RESPONSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-468-3123
Mailing Address - Street 1:409 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1141
Mailing Address - Country:US
Mailing Address - Phone:724-887-6822
Mailing Address - Fax:724-887-9440
Practice Address - Street 1:137 MAPLE DRIVE
Practice Address - Street 2:
Practice Address - City:SHOHOLA
Practice Address - State:PA
Practice Address - Zip Code:18458
Practice Address - Country:US
Practice Address - Phone:570-241-9070
Practice Address - Fax:570-686-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA171046OtherEMS