Healthcare Provider Details

I. General information

NPI: 1306867874
Provider Name (Legal Business Name): LOCK HAVEN EMERGENCY MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 S LIBERTY ST
LOCK HAVEN PA
17745-2570
US

IV. Provider business mailing address

PO BOX 11
LOCK HAVEN PA
17745-0011
US

V. Phone/Fax

Practice location:
  • Phone: 570-748-1611
  • Fax:
Mailing address:
  • Phone: 570-748-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier998572
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS NEPA
# 2
IdentifierHEALTH AMERICA
Identifier TypeOTHER
Identifier StatePA
Identifier Issuer30197
# 3
Identifier007464920008
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier212133
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BS
# 5
IdentifierHEALTH PARTNERS
Identifier TypeOTHER
Identifier StatePA
Identifier Issuer36376

VIII. Authorized Official

Name: GERARD L BANFILL
Title or Position: PRESIDENT
Credential:
Phone: 570-748-1611