Healthcare Provider Details

I. General information

NPI: 1063437846
Provider Name (Legal Business Name): WYSOX VOLUNTEER EMERGENCY MEDICAL SERVICE AMBULANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22537 ROUTE 187
WYSOX PA
18854-7742
US

IV. Provider business mailing address

PO BOX 302
WYSOX PA
18854-0302
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-9788
  • Fax: 570-265-3447
Mailing address:
  • Phone: 570-265-9788
  • Fax: 570-265-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GARY L PARKS
Title or Position: PRESIDENT/TREASURER
Credential:
Phone: 570-265-9788