Provider Demographics
NPI:1063567196
Name:SOUTH CENTRAL EMERGENCY MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:SOUTH CENTRAL EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF/C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:QUINN
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:NRCCEMTP
Authorized Official - Phone:717-671-4020
Mailing Address - Street 1:8065 ALLENTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9796
Mailing Address - Country:US
Mailing Address - Phone:717-671-4020
Mailing Address - Fax:717-671-4026
Practice Address - Street 1:8065 ALLENTOWN BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9796
Practice Address - Country:US
Practice Address - Phone:717-671-4020
Practice Address - Fax:717-671-4026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031643416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010078200006Medicaid
PA039EA11OtherCAPITAL BLUE CROSS PROVID
PA0010078200006Medicaid