Provider Demographics
NPI:1720058464
Name:SUBURBAN EMERGENCY MEDICAL SERVICES
Entity Type:Organization
Organization Name:SUBURBAN EMERGENCY MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-923-7500
Mailing Address - Street 1:PO BOX 3339
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:PA
Mailing Address - Zip Code:18043-3339
Mailing Address - Country:US
Mailing Address - Phone:610-253-0760
Mailing Address - Fax:610-253-7115
Practice Address - Street 1:3231 FREEMANSBURG AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-7118
Practice Address - Country:US
Practice Address - Phone:610-253-0760
Practice Address - Fax:610-253-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031913416L0300X, 343800000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007377810003Medicaid
PA1007377810003Medicaid