Healthcare Provider Details

I. General information

NPI: 1780615971
Provider Name (Legal Business Name): GEORGES CREEK AMBULANCE SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 UNION ST
LONACONING MD
21539-1137
US

IV. Provider business mailing address

PO BOX 155
LONACONING MD
21539-0155
US

V. Phone/Fax

Practice location:
  • Phone: 301-463-2295
  • Fax: 410-479-4793
Mailing address:
  • Phone: 301-463-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JAMES W DAWSON SR.
Title or Position: AMBULANCE COORDINATOR
Credential:
Phone: 301-463-2295