Provider Demographics
NPI:1174681712
Name:CITY OF LEBANON
Entity Type:Organization
Organization Name:CITY OF LEBANON
Other - Org Name:LEBANON FIRE DEPARTMENT AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPOULOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:603-448-8810
Mailing Address - Street 1:8 TURCOTTE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1706
Mailing Address - Country:US
Mailing Address - Phone:800-488-4351
Mailing Address - Fax:603-448-8811
Practice Address - Street 1:12 S. PARK STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-448-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF LEBANON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0203341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT49055OtherVT BCBS PROVIDER #
NH30820557Medicaid
NH590013846OtherRAILROAD MEDICARE
NHNH00235OtherNH BCBS PROVIDER #
VT0AM0075Medicaid
NHAM0075Medicare UPIN