Healthcare Provider Details

I. General information

NPI: 1396797007
Provider Name (Legal Business Name): CENTRE LIFELINK EMERGENCY MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PUDDINTOWN RD
STATE COLLEGE PA
16801-6825
US

IV. Provider business mailing address

PO BOX 272
STATE COLLEGE PA
16804-0272
US

V. Phone/Fax

Practice location:
  • Phone: 814-237-8163
  • Fax: 814-231-8788
Mailing address:
  • Phone: 814-237-8163
  • Fax: 814-231-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number03365
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number03365
License Number StatePA

VIII. Authorized Official

Name: KENT KNABLE
Title or Position: CHIEF
Credential:
Phone: 717-724-4136