Basic Information
| Provider Information | |||||||||
| NPI: | 1295715357 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH BRANCH EMERGENCY SERVICES INC | ||||||||
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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: | 48 OLD US HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087354012 | ||||||||
| FaxNumber: | 9087357125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | STORTZ | ||||||||
| AuthorizedOfficialFirstName: | MELINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9087354012 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3416L0300X | CLIN00134 | NJ | Y | Transportation Services | Ambulance | Land Transport |
ID Information
| ID | Type | State | Issuer | Description | 7218001 | 05 | NJ | MEDICAID |