=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003225590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VETERANS AMBULANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2014
-----------------------------------------------------
Last Update Date | 08/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2005 W CENTER ST
-----------------------------------------------------
City | TREMONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17981-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-789-3271
-----------------------------------------------------
Fax | 570-653-1193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2005 W CENTER ST
-----------------------------------------------------
City | TREMONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17981-1012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-789-3271
-----------------------------------------------------
Fax | 570-653-1193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MISS NICOLE WELCH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-789-3271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------