MEDICARE: WEST SHORE ADVANCED LIFE SUPPORT SERVICES, INC.

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	146N00000X	Basic Emergency Medical Technician	03060	PA
2	146L00000X	Paramedic	03060	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	:	1518960749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SHORE ADVANCED LIFE SUPPORT SERVICES, INC.

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-9800
Country	:	US
Telephone Number	:	800-367-0512
Fax Number	:	717-972-4753

Provider Business Practice Location Address
First Line	:	56 WOODBINE LN
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17821-8020
Country	:	US
Telephone Number	:	800-367-0512
Fax Number	:	717-972-4753

Authorized Official
Title or Position	:	DIRECTOR CREDENTIALING & ENROLLMENT
Name	:	CINDY MULL
Credential	:
Telephone Number	:	570-271-6144

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/21/2022

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