Healthcare Provider Details

I. General information

NPI: 1427038660
Provider Name (Legal Business Name): HOUTDALE EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 ELIZABETH STREET BOX 224
HOUTZDALE PA
16651-1322
US

IV. Provider business mailing address

816 ELIZABETH ST PO BOX 224
HOUTZDALE PA
16651-1322
US

V. Phone/Fax

Practice location:
  • Phone: 814-378-8622
  • Fax:
Mailing address:
  • Phone: 814-378-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number17012
License Number StatePA

VIII. Authorized Official

Name: SHELLY K TORMEY
Title or Position: BILLING DEPT.
Credential:
Phone: 814-378-8622