MEDICARE: VOLUNTEER FIRE CO OF PICTURE ROCKS PA 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	341600000X	Ambulance	03342	PA

General Provider Information

NPI Number	:	1952585846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOLUNTEER FIRE CO OF PICTURE ROCKS PA INC

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	PICTURE ROCKS
State	:	PA
Zip	:	17762-0367
Country	:	US
Telephone Number	:	570-584-4115
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 N MAIN ST
Second Line	:
City	:	PICTURE ROCKS
State	:	PA
Zip	:	17762
Country	:	US
Telephone Number	:	570-584-4115
Fax Number	:

Authorized Official
Title or Position	:	AMBULANCE CAPTAIN
Name	:	ROBERTA L PHILIPS
Credential	:
Telephone Number	:	570-584-4115

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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