=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861497893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHLEEN M MINNICH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2005
-----------------------------------------------------
Last Update Date | 08/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 E PENN AVE
-----------------------------------------------------
City | CLEONA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17042-2429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-270-1070
-----------------------------------------------------
Fax | 717-273-8373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3632 HILL CHURCH RD
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17046-9350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-270-1070
-----------------------------------------------------
Fax | 717-273-8373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHLEEN M. MINNICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-270-1070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------