=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023001369
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MURRYSVILLE MEDIC NO 1
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2005
-----------------------------------------------------
Last Update Date | 06/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3237 SARDIS RD
-----------------------------------------------------
City | MURRYSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15668-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-327-1222
-----------------------------------------------------
Fax | 724-327-7686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 18533
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15236-0533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-327-1222
-----------------------------------------------------
Fax | 724-234-4703
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATIVE DIRECTOR
-----------------------------------------------------
Name | MR. JAMES DARRICK GERANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-325-4003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 03001
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------