Organization
SOUTH MOUNTAIN VOLUNTEER FIRE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY J STALEY (EMS SUPERVIOR)
(717) 749-5733
Entity
Organization
Contact information
Practice address
11207 LOOP RD, FAYETTEVILLE, PA 17222-9284
(717) 749-5733
(717) 749-5219
Mailing address
PO BOX 92, SOUTH MOUNTAIN, PA 17261-0092
(717) 749-5733
(717) 749-5219
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018234600001
—
PA
05
—
3810002579
—
WV
05
—
411464700
—
MD
Enumeration date
08/18/2005
Last updated
01/21/2013
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