MEDICARE: PORT MATILDA EMERGENCY MEDICAL SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	04145	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316948011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORT MATILDA EMERGENCY MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 726
Second Line	:
City	:	NEW CUMBERLAND
State	:	PA
Zip	:	17070-0726
Country	:	US
Telephone Number	:	717-214-6018
Fax Number	:	717-214-6020

Provider Business Practice Location Address
First Line	:	402 S HIGH ST
Second Line	:
City	:	PORT MATILDA
State	:	PA
Zip	:	16870
Country	:	US
Telephone Number	:	814-692-1035
Fax Number	:	814-692-1030

Authorized Official
Title or Position	:	TREASURER
Name	:	KAREN BROWN
Credential	:
Telephone Number	:	814-692-1035

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	10/21/2011

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Directions to “PORT MATILDA EMERGENCY MEDICAL SERVICES ” Practice Location

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