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General NPI Number Information
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NPI Number | 1114925997
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Entity Type | Organization
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Legal Business Name | JACOBUS LIONS AMBULANCE CLUB
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 18 S MAIN ST
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City | JACOBUS
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State | PA
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Zip | 17407-1304
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Country | US
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Telephone | 717-428-0218
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Fax | 717-428-3259
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Provider Business Mailing Address
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Address Line | 18 S MAIN ST
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City | JACOBUS
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State | PA
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Zip | 17407-1304
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Country | US
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Telephone | 717-428-0218
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Fax | 717-428-3259
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Authorized Official
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Title or Position | ACTING CHIEF
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Name | CHRISTOPHER KROUSE
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Credential |
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Telephone | 717-378-1090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 02228
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License Number State | PA
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