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General NPI Number Information
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NPI Number | 1609958792
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Entity Type | Organization
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Legal Business Name | 549 CORPORATION
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 645 MAIN STREET
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City | EDWARDSVILLE
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State | PA
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Zip | 18704
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Country | US
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Telephone | 570-288-5770
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Fax | 570-288-0112
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Provider Business Mailing Address
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Address Line | 645 MAIN STREET
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City | EDWARDSVILLE
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State | PA
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Zip | 18704
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Country | US
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Telephone | 570-288-5770
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Fax | 570-288-0112
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL KOWALSKI
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Credential |
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Telephone | 570-288-5770
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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 | 03367
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License Number State | PA
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