Healthcare Provider Details

I. General information

NPI: 1023000767
Provider Name (Legal Business Name): SOUTHERN BLAIR EMERGENCY MEDICAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 MANSION DR
CLAYSBURG PA
16625
US

IV. Provider business mailing address

PO BOX 726
NEW CUMBERLAND PA
17070-0726
US

V. Phone/Fax

Practice location:
  • Phone: 814-239-9353
  • Fax: 814-239-9355
Mailing address:
  • Phone: 717-214-6018
  • Fax: 717-214-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03346
License Number StatePA

VIII. Authorized Official

Name: MICHAEL GROVE
Title or Position: MANAGER
Credential:
Phone: 814-239-9353