Healthcare Provider Details

I. General information

NPI: 1891879573
Provider Name (Legal Business Name): MATAMORAS EMERGENCY SQUAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GRANDVIEW AVE
NEW MATAMORAS OH
45767-1111
US

IV. Provider business mailing address

PO BOX 114
NEW MATAMORAS OH
45767-0114
US

V. Phone/Fax

Practice location:
  • Phone: 740-865-2904
  • Fax:
Mailing address:
  • Phone: 740-865-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateOH

VIII. Authorized Official

Name: JAMES F HUPP
Title or Position: SQUAD CAPTAIN
Credential:
Phone: 740-865-2904