Provider Demographics
NPI:1336297969
Name:LAKE CITY FIRE COMPANY
Entity Type:Organization
Organization Name:LAKE CITY FIRE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY CHIEF EMS
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:JOBCZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-774-4402
Mailing Address - Street 1:2232 RICE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16423-1552
Mailing Address - Country:US
Mailing Address - Phone:814-774-4402
Mailing Address - Fax:814-774-9556
Practice Address - Street 1:2232 RICE AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:PA
Practice Address - Zip Code:16423-1552
Practice Address - Country:US
Practice Address - Phone:814-774-4402
Practice Address - Fax:814-774-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA04123341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA590001354OtherRAILROAD MEDICARE
PA0011498700003Medicaid
PA000205083OtherBLUE CROSS
PA000205083OtherBLUE CROSS