Healthcare Provider Details

I. General information

NPI: 1720287527
Provider Name (Legal Business Name): LILLY AREA AMBULANCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 MAIN ST
LILLY PA
15938-1143
US

IV. Provider business mailing address

421 MAIN ST PO BOX 6
LILLY PA
15938-1143
US

V. Phone/Fax

Practice location:
  • Phone: 814-886-5700
  • Fax: 814-886-9353
Mailing address:
  • Phone: 814-886-5700
  • Fax: 814-886-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number03153
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012211040001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MRS. NATALIE ANN BARLICKREED
Title or Position: SECRETARY
Credential:
Phone: 814-886-5700