=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144289141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMPDEN TOWNSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2006
-----------------------------------------------------
Last Update Date | 08/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 S SPORTING HILL RD
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17050-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-761-0119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 S SPORTING HILL RD
-----------------------------------------------------
City | MECHANICSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17050-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TOWNSHIP MANAGER
-----------------------------------------------------
Name | MR. KEITH B METTS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-761-0119
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 04059
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------