MEDICARE: FIVEPOINTVILLE AMBULANCE SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	04155	PA

General Provider Information

NPI Number	:	1295731198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIVEPOINTVILLE AMBULANCE SERVICE

Provider Business Mailing Address
First Line	:	PO BOX 726
Second Line	:
City	:	NEW CUMBERLAND
State	:	PA
Zip	:	17070-0726
Country	:	US
Telephone Number	:	717-214-6018
Fax Number	:	717-214-6020

Provider Business Practice Location Address
First Line	:	1094 DRY TAVERN RD
Second Line	:
City	:	DENVER
State	:	PA
Zip	:	17517-8953
Country	:	US
Telephone Number	:	717-445-5937
Fax Number	:	717-445-9960

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DENNIS MARTIN
Credential	:
Telephone Number	:	717-445-5937

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	02/06/2008

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