Healthcare Provider Details

I. General information

NPI: 1063442739
Provider Name (Legal Business Name): BOONSBORO AMBULANCE AND RESCUE SERVICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 OLD NATIONAL PIKE
BOONSBORO MD
21713-2003
US

IV. Provider business mailing address

7619 OLD NATIONAL PIKE PO BOX 7
BOONSBORO MD
21713-2003
US

V. Phone/Fax

Practice location:
  • Phone: 301-432-6979
  • Fax: 301-432-2265
Mailing address:
  • Phone: 301-432-6979
  • Fax: 301-432-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number31077804
License Number StateMD

VIII. Authorized Official

Name: MS. MARY J BLICKENSTAFF
Title or Position: PRESIDENT
Credential: PARAMEDIC
Phone: 301-432-6979