Healthcare Provider Details

I. General information

NPI: 1083602114
Provider Name (Legal Business Name): LAKE MEADE FIRE & RESCUE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 LAKE MEADE DR
EAST BERLIN PA
17316-9345
US

IV. Provider business mailing address

PO BOX 207
ALLENTOWN PA
18105-0207
US

V. Phone/Fax

Practice location:
  • Phone: 717-259-8338
  • Fax:
Mailing address:
  • Phone: 484-664-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03130
License Number StatePA

VIII. Authorized Official

Name: JULIE BRANDT
Title or Position: TRUSTEE ASSISTANT CHIEF
Credential:
Phone: 717-259-8338