Healthcare Provider Details

I. General information

NPI: 1861497893
Provider Name (Legal Business Name): KATHLEEN M MINNICH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E PENN AVE
CLEONA PA
17042-2429
US

IV. Provider business mailing address

3632 HILL CHURCH RD
LEBANON PA
17046-9350
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-1070
  • Fax: 717-273-8373
Mailing address:
  • Phone: 717-270-1070
  • Fax: 717-273-8373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN M. MINNICH
Title or Position: OWNER
Credential:
Phone: 717-270-1070