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General NPI Number Information
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NPI Number | 1669561734
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Entity Type | Organization
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Legal Business Name | PORTERSVILLE MUDDY CREEK VOL EMS RESCUE, INC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 1122 WEST PORTERSVILLE ROAD
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City | PORTERSVILLE
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State | PA
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Zip | 16051-2314
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Country | US
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Telephone | 724-368-8813
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Fax | 724-794-1633
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Provider Business Mailing Address
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Address Line | 892 NEW CASTLE RD
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City | SLIPPERY ROCK
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State | PA
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Zip | 16057-4228
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Country | US
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Telephone | 800-280-5947
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Fax | 724-794-1633
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CRAIG LEE BOOK
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Credential |
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Telephone | 724-363-8813
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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 | 04137
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License Number State | PA
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