Healthcare Provider Details

I. General information

NPI: 1720220452
Provider Name (Legal Business Name): DAMASCUS TOWNSHIP VOLUNTEER AMBULANCE CORPS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 COCHECTON TPKE
TYLER HILL PA
18469-4004
US

IV. Provider business mailing address

PO BOX 63
DAMASCUS PA
18415-0063
US

V. Phone/Fax

Practice location:
  • Phone: 570-224-4552
  • Fax: 570-224-4552
Mailing address:
  • Phone: 570-729-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number05051
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSH SHEARD
Title or Position: AMBULANCE CAPTAIN
Credential:
Phone: 570-729-1020