MEDICARE: DAMASCUS TOWNSHIP VOLUNTEER AMBULANCE CORPS 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	3416L0300X	Land Ambulance	05051	PA

General Provider Information

NPI Number	:	1720220452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMASCUS TOWNSHIP VOLUNTEER AMBULANCE CORPS INC

Provider Business Mailing Address
First Line	:	PO BOX 63
Second Line	:
City	:	DAMASCUS
State	:	PA
Zip	:	18415-0063
Country	:	US
Telephone Number	:	570-729-1020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 COCHECTON TPKE
Second Line	:
City	:	TYLER HILL
State	:	PA
Zip	:	18469-4004
Country	:	US
Telephone Number	:	570-224-4552
Fax Number	:	570-224-4552

Authorized Official
Title or Position	:	AMBULANCE CAPTAIN
Name	:	JOSH SHEARD
Credential	:
Telephone Number	:	570-729-1020

Provider Enumeration Date	:	03/26/2009
Last Update Date	:	05/13/2009

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