Provider Demographics
NPI:1063437846
Name:WYSOX VOLUNTEER EMERGENCY MEDICAL SERVICE AMBULANCE INC
Entity type:Organization
Organization Name:WYSOX VOLUNTEER EMERGENCY MEDICAL SERVICE AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-265-9788
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:WYSOX
Mailing Address - State:PA
Mailing Address - Zip Code:18854-0302
Mailing Address - Country:US
Mailing Address - Phone:570-265-9788
Mailing Address - Fax:570-265-3447
Practice Address - Street 1:22537 ROUTE 187
Practice Address - Street 2:
Practice Address - City:WYSOX
Practice Address - State:PA
Practice Address - Zip Code:18854-7742
Practice Address - Country:US
Practice Address - Phone:570-265-9788
Practice Address - Fax:570-265-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011597600003Medicaid
PA287494Medicare PIN