MEDICARE: LAKE CITY FIRE COMPANY

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	341600000X	Ambulance	04123	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590001354	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000205083	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1336297969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE CITY FIRE COMPANY

Provider Business Mailing Address
First Line	:	2232 RICE AVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-1552
Country	:	US
Telephone Number	:	814-774-4402
Fax Number	:	814-774-9556

Provider Business Practice Location Address
First Line	:	2232 RICE AVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-1552
Country	:	US
Telephone Number	:	814-774-4402
Fax Number	:	814-774-9556

Authorized Official
Title or Position	:	DEPUTY CHIEF EMS
Name	:	ELIZABETH FRANCES JOBCZYNSKI
Credential	:
Telephone Number	:	814-774-4402

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/19/2016

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Directions to “LAKE CITY FIRE COMPANY ” Practice Location

Language	Start Address	Practice Location

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