Provider Demographics
NPI:1083602114
Name:LAKE MEADE FIRE & RESCUE INC
Entity Type:Organization
Organization Name:LAKE MEADE FIRE & RESCUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE ASSISTANT CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-259-8338
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-0207
Mailing Address - Country:US
Mailing Address - Phone:484-664-2007
Mailing Address - Fax:
Practice Address - Street 1:492 LAKE MEADE DR
Practice Address - Street 2:
Practice Address - City:EAST BERLIN
Practice Address - State:PA
Practice Address - Zip Code:17316-9345
Practice Address - Country:US
Practice Address - Phone:717-259-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031303416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017519150001Medicaid
0899588OtherAETNA USHC BLUE BELL HMO
PA284924OtherBCBS
0899588OtherAETNA USHC BLUE BELL HMO
=========OtherKEYSTONE HP CTRL HMO MDC
PA284924Medicare PIN