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General NPI Number Information
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NPI Number | 1609081033
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Entity Type | Organization
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Legal Business Name | LAKE SHORE FIRE DEPARTMENT
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 5310 W LAKE RD
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City | ERIE
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State | PA
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Zip | 16505-2869
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Country | US
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Telephone | 814-833-6508
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Fax |
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Provider Business Mailing Address
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Address Line | 5310 W LAKE RD PO BOX 8566
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City | ERIE
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State | PA
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Zip | 16505-2869
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SARA O'BRIEN
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Credential |
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Telephone | 814-833-6508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 04166
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License Number State | PA
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