=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053316398
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION COUNTY WEST END AMBULANCE ASSOCIATION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2005
-----------------------------------------------------
Last Update Date | 10/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3005 STATE ROUTE 235
-----------------------------------------------------
City | MILLMONT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17845-9561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-922-1120
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51
-----------------------------------------------------
City | LAURELTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17835-0051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-922-1120
-----------------------------------------------------
Fax | 570-922-0347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THOMAS M PERRIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-922-1120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------