Healthcare Provider Details

I. General information

NPI: 1295715357
Provider Name (Legal Business Name): SOUTH BRANCH EMERGENCY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 OLD US HIGHWAY 22
CLINTON NJ
08809
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 908-735-4012
  • Fax: 908-735-7125
Mailing address:
  • Phone: 484-664-2007
  • Fax: 484-664-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License NumberCLIN00134
License Number StateNJ

VIII. Authorized Official

Name: MS. MELINDA STORTZ
Title or Position: PRESIDENT
Credential:
Phone: 908-735-4012