=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790763761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESCUE 14 EMS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2006
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 EDNA RD
-----------------------------------------------------
City | ADAMSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15611-9728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-523-5609
-----------------------------------------------------
Fax | 724-527-2755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 175
-----------------------------------------------------
City | ADAMSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15611-0175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-523-5609
-----------------------------------------------------
Fax | 724-527-2755
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DON THOMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-523-5609
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 02125
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------