=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619008265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLOUCESTER TOWNSHIP EMS ALLIANCE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 12/19/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 N BLACK HORSE PIKE SUITE 5D
-----------------------------------------------------
City | BLACKWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08012-3098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-481-8429
-----------------------------------------------------
Fax | 856-481-4930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1016
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-7016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-784-3715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RAY CURREY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-481-4829
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | GEB0032
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------