Organization
BACK MOUNTAIN REGIONAL FIRE AND EMS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK VANETTEN (PRESIDENT)
(570) 675-0636
Entity
Organization
Contact information
Practice address
184 E CENTER HILL RD, DALLAS, PA 18612-1154
(570) 675-0636
(570) 675-3883
Mailing address
PO BOX 176, DALLAS, PA 18612-0176
(570) 675-0636
(570) 675-3883
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016641770001
—
PA
01
—
080036800
FEDERAL BLACK LUNG
PA
01
—
338170
HEALTH AMERICA
PA
Enumeration date
09/27/2006
Last updated
06/13/2013
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