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General NPI Number Information
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NPI Number | 1255456968
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Entity Type | Organization
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Legal Business Name | SOUTH FORK AMBULANCE ASSOCIATION
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 28 MALL STREET
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City | SOUTH FORK
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State | CO
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Zip | 81154
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Country | US
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Telephone | 800-473-2278
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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 | OFFICE MANAGER
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Name | TERI BRYD
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Credential |
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Telephone | 719-852-2362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number |
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License Number State |
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Taxonomy #2
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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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