# ICKESBURG AMBULANCE ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023179132
- **Authorized official:** SHANE M WOLF (PRESIDENT)
- **Authorized official phone:** (717) 438-0384

## Contact information

- **Practice address:** 10350 RACCOON VALLEY RD, ICKESBURG, PA 17037
- **Practice address phone:** (717) 438-3113
- **Mailing address:** PO BOX 163, ICKESBURG, PA 17037-0163
- **Mailing address phone:** (717) 438-3113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 146N00000X | Basic Emergency Medical Technician | 04274 | PA | Yes |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 02/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001437455 | — | PA |