Provider Demographics
NPI:1932477684
Name:PORT MATILDA EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:PORT MATILDA EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-692-1035
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-0726
Mailing Address - Country:US
Mailing Address - Phone:814-692-1035
Mailing Address - Fax:814-692-1030
Practice Address - Street 1:402 S HIGH ST
Practice Address - Street 2:
Practice Address - City:PORT MATILDA
Practice Address - State:PA
Practice Address - Zip Code:16870-0495
Practice Address - Country:US
Practice Address - Phone:814-692-1035
Practice Address - Fax:814-692-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA041453416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport