Organization
JESSUP HOSE CO 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE FARAMELLI (CHIEF)
(570) 489-1141
Entity
Organization
Contact information
Practice address
333 HILL ST, JESSUP, PA 18434-1036
(570) 498-1141
Mailing address
PO BOX 1846, SHAVERTOWN, PA 18708-0846
(570) 714-3694
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
05117
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011760450001
—
PA
01
—
800356
FEDERAL BLACK LUNG
—
Enumeration date
12/06/2006
Last updated
06/04/2009
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