Basic Information
| Provider Information | |||||||||
| NPI: | 1073509147 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNT MORRIS EMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 207 | ||||||||
| Address2: | |||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181050207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846642007 | ||||||||
| FaxNumber: | 4846642015 | ||||||||
| Practice Location | |||||||||
| Address1: | MAIN ST | ||||||||
| Address2: | AMERICAN LEGION HALL | ||||||||
| City: | MT MORRIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243242041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 09/28/2007 | ||||||||
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| AuthorizedOfficialLastName: | BENNETT | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7243245212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | EMT E026573 | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 0014463100004 | 05 | PA | MEDICAID | 219279 | 01 | PA | BCBS OF PA | OTHER |