=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982696621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVER SPRING AMBULANCE & RESCUE ASSOCIATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2005
-----------------------------------------------------
Last Update Date | 10/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 ELEANOR DR
-----------------------------------------------------
City | NEW KINGSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-697-3131
-----------------------------------------------------
Fax | 717-697-4614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 726
-----------------------------------------------------
City | NEW CUMBERLAND
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17070-0726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-214-6018
-----------------------------------------------------
Fax | 717-214-6020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JAN NAGLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-697-3131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 06092
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------