MEDICARE: BOYERTOWN LIONS COMMUNITY AMBULANCE SERVICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	06005	PA

General Provider Information

NPI Number	:	1811973217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOYERTOWN LIONS COMMUNITY AMBULANCE SERVICE, INC.

Provider Business Mailing Address
First Line	:	2 E 2ND ST
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-1541
Country	:	US
Telephone Number	:	610-367-2330
Fax Number	:	610-369-2902

Provider Business Practice Location Address
First Line	:	2 E 2ND ST
Second Line	:
City	:	BOYERTOWN
State	:	PA
Zip	:	19512-1541
Country	:	US
Telephone Number	:	610-367-2330
Fax Number	:	610-369-2902

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	GREGORY SCOTT HERBST SR.
Credential	:
Telephone Number	:	610-367-2330

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	08/22/2020

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