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General NPI Number Information
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NPI Number | 1023030939
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Entity Type | Organization
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Legal Business Name | PIKE COUNTY ADVANCED LIFE SUPPORT INC
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 149 SAWKILL AVE
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City | MILFORD
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State | PA
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Zip | 18337-1141
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Country | US
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Telephone | 570-296-2580
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Fax | 570-832-2164
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Provider Business Mailing Address
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Address Line | PO BOX 384
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City | DINGMANS FERRY
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State | PA
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Zip | 18328-0384
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Country | US
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Telephone | 570-296-2580
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Fax | 570-832-2164
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY LOU CORBETT
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Credential |
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Telephone | 570-828-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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