=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861488934
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAMBURG EMERGENCY MEDICAL SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 05/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 564 FRANKLIN ST
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19526-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-562-5562
-----------------------------------------------------
Fax | 610-562-7543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 24
-----------------------------------------------------
City | ELVERSON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19520-0024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-286-5076
-----------------------------------------------------
Fax | 610-286-5079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SANDRA LEE KIEFFER
-----------------------------------------------------
Credential | EMT
-----------------------------------------------------
Telephone | 484-818-1732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 03398
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------