Organization Name: | WYSOX VOLUNTEER EMERGENCY MEDICAL SERVICE AMBULANCE INC |
NPI Number: | 1063437846 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JUSTIN POLZELLA (PRESIDENT) |
Mailing Address: | 1 State Route 187 S Wysox |
State: | PA US |
Postal Code: | 18854 |
Phone Number: | 5702659788 |
Fax Number: | 5702653447 |
NPI Enumeration Date: | 07/13/2006 |
NPI Last Update Date: | 11/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3416L0300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Transportation Services |
Taxonomy Classification: | Ambulance |
Taxonomy Specialization: | Land Transport |
Taxonomy Definition: |