=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265566913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN ALLIANCE EMERGENCY SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 06/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 CANTON ST
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16947-1444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-297-1235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 13
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16947-0013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-297-1235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR-CEO
-----------------------------------------------------
Name | THOMAS CARMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 570-297-1235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------