Healthcare Provider Details
I. General information
NPI: 1619008265
Provider Name (Legal Business Name): GLOUCESTER TOWNSHIP EMS ALLIANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/07/2007
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
109 N BLACK HORSE PIKE SUITE 5D
BLACKWOOD NJ
08012-3098
US
IV. Provider business mailing address
PO BOX 1016
VOORHEES NJ
08043-7016
US
V. Phone/Fax
- Phone: 856-481-8429
- Fax: 856-481-4930
- Phone: 856-784-3715
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 341600000X |
| Taxonomy | Ambulance |
| License Number | GEB0032 |
| License Number State | NJ |
VIII. Authorized Official
Name:
RAY
CURREY
Title or Position: PRESIDENT
Credential:
Phone: 856-481-4829