Provider Demographics
NPI:1497427371
Name:LUTZ, BRUCE ALLEN JR
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALLEN
Last Name:LUTZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1127
Mailing Address - Country:US
Mailing Address - Phone:570-294-7981
Mailing Address - Fax:
Practice Address - Street 1:274 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1127
Practice Address - Country:US
Practice Address - Phone:570-294-7981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)