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
State | License ID | Taxonomies |
---|---|---|
PA | 04145 | 3416L0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 3416L0300X | Transportation Services | Ambulance | Land Transport |