Provider Demographics
NPI:1740261007
Name:WEST SCHUYLKILL ADVANCED LIFE SUPPORT INC.
Entity type:Organization
Organization Name:WEST SCHUYLKILL ADVANCED LIFE SUPPORT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-695-2500
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-0539
Mailing Address - Country:US
Mailing Address - Phone:717-938-1690
Mailing Address - Fax:717-938-1690
Practice Address - Street 1:49 NORTH ST
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:PA
Practice Address - Zip Code:17981-1526
Practice Address - Country:US
Practice Address - Phone:570-695-2500
Practice Address - Fax:570-695-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-12
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA042563416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015876400003Medicaid
PA238491Medicare ID - Type Unspecified