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General NPI Number Information
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NPI Number | 1336204577
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Entity Type | Organization
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Legal Business Name | B.L. GUSTAFSON, LLC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 18 E WILLOW ST
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City | SMETHPORT
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State | PA
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Zip | 16749-1508
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Country | US
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Telephone | 814-887-1982
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | SMETHPORT
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State | PA
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Zip | 16749-0344
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Country | US
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Telephone | 814-887-1982
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BRIAN GUSTAFSON
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Credential |
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Telephone | 814-887-1982
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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 | 04097
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License Number State | PA
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