Healthcare Provider Details

I. General information

NPI: 1558029165
Provider Name (Legal Business Name): PROFESSIONAL MEDICAL RESPONSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 03/29/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 MAPLE DRIVE
SHOHOLA PA
18458
US

IV. Provider business mailing address

409 PORTER AVE
SCOTTDALE PA
15683-1141
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-9070
  • Fax: 570-686-0010
Mailing address:
  • Phone: 724-887-6822
  • Fax: 724-887-9440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KYLE MIHALIK
Title or Position: CEO
Credential:
Phone: 570-468-3123