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General NPI Number Information
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NPI Number | 1043206014
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Entity Type | Organization
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Legal Business Name | KINGSTON FIREMENS COMMUNITY AMBULANCE
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 600 WYOMING AVE
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City | KINGSTON
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State | PA
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Zip | 18704-3702
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Country | US
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Telephone | 570-714-0471
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 207
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City | ALLENTOWN
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State | PA
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Zip | 18105-0207
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Country | US
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Telephone | 484-664-2007
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JOE GRIMES
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Credential |
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Telephone | 570-714-0471
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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 | 03370
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License Number State | PA
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