Healthcare Provider Details

I. General information

NPI: 1578562302
Provider Name (Legal Business Name): LACK TUSCARORA EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 ROUTE 75 SOUTH
EAST WATERFORD PA
17021-0096
US

IV. Provider business mailing address

PO BOX 98
ENOLA PA
17025-0098
US

V. Phone/Fax

Practice location:
  • Phone: 717-734-3959
  • Fax: 717-734-9599
Mailing address:
  • Phone: 717-728-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number05133
License Number StatePA

VIII. Authorized Official

Name: CHRISTOPHER DAVID YARNALL
Title or Position: EMS CHIEF
Credential: EMT-B
Phone: 717-734-3959