Healthcare Provider Details

I. General information

NPI: 1205828944
Provider Name (Legal Business Name): SOUTH MOUNTAIN VOLUNTEER FIRE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 01/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11207 LOOP RD
FAYETTEVILLE PA
17222-9284
US

IV. Provider business mailing address

PO BOX 92
SOUTH MOUNTAIN PA
17261-0092
US

V. Phone/Fax

Practice location:
  • Phone: 717-749-5733
  • Fax: 717-749-5219
Mailing address:
  • Phone: 717-749-5733
  • Fax: 717-749-5219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STACY J STALEY
Title or Position: EMS SUPERVIOR
Credential:
Phone: 717-749-5733