Provider Demographics
NPI:1336531664
Name:NORTHEASTERN BERKS EMERGENCY MEDICAL SERVICE, INC.
Entity Type:Organization
Organization Name:NORTHEASTERN BERKS EMERGENCY MEDICAL SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMCHYK
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-PARAMEDIC
Authorized Official - Phone:484-866-0392
Mailing Address - Street 1:220 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1524
Mailing Address - Country:US
Mailing Address - Phone:484-294-0828
Mailing Address - Fax:610-683-5013
Practice Address - Street 1:220 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-1524
Practice Address - Country:US
Practice Address - Phone:484-294-0828
Practice Address - Fax:610-683-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA160543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport