Provider Demographics
NPI:1568502441
Name:SKIPPACK EMERGENCY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SKIPPACK EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-964-2869
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:4058 MENSCH ROAD
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-0059
Mailing Address - Country:US
Mailing Address - Phone:610-454-9665
Mailing Address - Fax:610-454-9666
Practice Address - Street 1:4058 MENSCH ROAD
Practice Address - Street 2:
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-0059
Practice Address - Country:US
Practice Address - Phone:610-454-9665
Practice Address - Fax:610-454-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03167341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1264943Medicaid
PA208378Medicare ID - Type Unspecified