MEDICARE: LAKE MEADE FIRE & RESCUE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	03130	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0899588	OTHER		AETNA USHC BLUE BELL HMO
3	284924	OTHER	PA	BCBS

General Provider Information

NPI Number	:	1083602114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE MEADE FIRE & RESCUE INC

Provider Business Mailing Address
First Line	:	PO BOX 207
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18105-0207
Country	:	US
Telephone Number	:	484-664-2007
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 LAKE MEADE DR
Second Line	:
City	:	EAST BERLIN
State	:	PA
Zip	:	17316-9345
Country	:	US
Telephone Number	:	717-259-8338
Fax Number	:

Authorized Official
Title or Position	:	TRUSTEE ASSISTANT CHIEF
Name	:	JULIE BRANDT
Credential	:
Telephone Number	:	717-259-8338

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/01/2011

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