Provider Demographics
NPI:1790763753
Name:LAWRENCE PARK VOLUNTEER FIRE DEPT LAWRENCE PARK
Entity Type:Organization
Organization Name:LAWRENCE PARK VOLUNTEER FIRE DEPT LAWRENCE PARK
Other - Org Name:LAWRENCE PARK VFD AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-899-4988
Mailing Address - Street 1:4102 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16511-1968
Mailing Address - Country:US
Mailing Address - Phone:814-899-4988
Mailing Address - Fax:814-898-2103
Practice Address - Street 1:4102 MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16511-1968
Practice Address - Country:US
Practice Address - Phone:814-899-4988
Practice Address - Fax:814-898-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA021633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032238800001Medicaid
PA000000141894OtherUNISON
PA283940OtherBLUE CROSS/BLUE SHIELD
PA0011023460003Medicaid
PA0011023460003Medicaid