Healthcare Provider Details

I. General information

NPI: 1124029061
Provider Name (Legal Business Name): PROVIDENCE TOWNSHIP AMBULANCE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PENNSY RD
NEW PROVIDENCE PA
17560-9402
US

IV. Provider business mailing address

PO BOX 726
NEW CUMBERLAND PA
17070-0726
US

V. Phone/Fax

Practice location:
  • Phone: 717-786-4572
  • Fax: 717-806-2029
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 Number05058
License Number StatePA

VIII. Authorized Official

Name: RICHARD DULL
Title or Position: PRESIDENT
Credential:
Phone: 717-786-4572