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Organization
ICKESBURG AMBULANCE ASSOCIATION
Active
Organization
ICKESBURG AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE M WOLF (PRESIDENT)
(717) 438-0384
Entity
Organization
Contact information
Practice address
10350 RACCOON VALLEY RD, ICKESBURG, PA 17037
(717) 438-3113
Mailing address
PO BOX 163, ICKESBURG, PA 17037-0163
(717) 438-3113
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
04274
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001437455
—
PA
Enumeration date
12/12/2006
Last updated
02/10/2012
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