Provider Demographics
NPI:1578562302
Name:LACK TUSCARORA EMS
Entity Type:Organization
Organization Name:LACK TUSCARORA EMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:YARNALL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:717-734-3959
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-0098
Mailing Address - Country:US
Mailing Address - Phone:717-728-9223
Mailing Address - Fax:
Practice Address - Street 1:9320 ROUTE 75 SOUTH
Practice Address - Street 2:
Practice Address - City:EAST WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:17021-0096
Practice Address - Country:US
Practice Address - Phone:717-734-3959
Practice Address - Fax:717-734-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05133341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001587256Medicaid
PA001587256Medicaid