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General NPI Number Information
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NPI Number | 1578810917
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN EMERGENCY MEDICAL SERVICE
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 3855 HEATON ROAD
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1803
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Country | US
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Telephone | 215-354-4443
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Fax | 215-354-4453
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Provider Business Mailing Address
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Address Line | 3855 HEATON ROAD
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-1803
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Country | US
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Telephone | 215-354-4443
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Fax | 215-354-4453
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. DANIEL JOSEPH PICCILLO
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Credential |
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Telephone | 215-354-4443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 12036
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License Number State | PA
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