Provider Demographics
NPI:1205432051
Name:PHOENIX EMS INC.
Entity type:Organization
Organization Name:PHOENIX EMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIRSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-366-3464
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-0124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3232 W VALLEY RD
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749-3238
Practice Address - Country:US
Practice Address - Phone:814-598-6468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance