Healthcare Provider Details

I. General information

NPI: 1316097462
Provider Name (Legal Business Name): PLYMOUTH BOROUGH AMBULANCE ASSOC. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GAYLORD AVE
PLYMOUTH PA
18651-2202
US

IV. Provider business mailing address

24 GAYLORD AVE
PLYMOUTH PA
18651-2202
US

V. Phone/Fax

Practice location:
  • Phone: 570-779-9878
  • Fax: 570-779-4666
Mailing address:
  • Phone: 570-779-9878
  • Fax: 570-779-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number04175
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT MILLER
Title or Position: PRESIDENT
Credential:
Phone: 570-779-4388