Healthcare Provider Details

I. General information

NPI: 1538146196
Provider Name (Legal Business Name): MIFFLINBURG COMMUNITY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CHESTNUT ST
MIFFLINBURG PA
17844-1314
US

IV. Provider business mailing address

104 CHESTNUT ST
MIFFLINBURG PA
17844-1314
US

V. Phone/Fax

Practice location:
  • Phone: 570-966-6880
  • Fax:
Mailing address:
  • Phone: 570-966-6880
  • Fax:

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 MAST
Title or Position: CAPTAIN/DIRECTOR
Credential:
Phone: 570-966-6880