Provider Demographics
NPI:1306986104
Name:SUSSEX POST 8 AMERICAN LEGION GEORGETOWN AMBULANCE SERV
Entity type:Organization
Organization Name:SUSSEX POST 8 AMERICAN LEGION GEORGETOWN AMBULANCE SERV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-653-3557
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-0128
Mailing Address - Country:US
Mailing Address - Phone:302-653-3557
Mailing Address - Fax:302-653-3552
Practice Address - Street 1:406 N FRONT ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1134
Practice Address - Country:US
Practice Address - Phone:302-653-3557
Practice Address - Fax:302-653-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA93 B933416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE287531Medicare PIN