Healthcare Provider Details

I. General information

NPI: 1215026935
Provider Name (Legal Business Name): CHICORA INDEPENDENT HOSE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WEST SLIPPERY ROCK ST
CHICORA PA
16025-3214
US

IV. Provider business mailing address

202 WEST SLIPPERY ROCK ST
CHICORA PA
16025-3214
US

V. Phone/Fax

Practice location:
  • Phone: 724-445-2220
  • Fax: 724-445-2167
Mailing address:
  • Phone: 724-445-2220
  • Fax: 724-445-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number06004
License Number StatePA

VIII. Authorized Official

Name: MR. MICHAEL TURNER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 724-445-2220