Provider Demographics
NPI:1891911863
Name:LANDISBURG FIRE COMPANY AMBULANCE CLUB
Entity Type:Organization
Organization Name:LANDISBURG FIRE COMPANY AMBULANCE CLUB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-789-3080
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:LANDISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17040
Mailing Address - Country:US
Mailing Address - Phone:717-789-3080
Mailing Address - Fax:
Practice Address - Street 1:301 FACULTY ST
Practice Address - Street 2:
Practice Address - City:LANDISBURG
Practice Address - State:PA
Practice Address - Zip Code:17040
Practice Address - Country:US
Practice Address - Phone:717-789-0190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3416L0300XTransportation ServicesAmbulanceLand TransportGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007036640004Medicaid
PA0007036640001Medicaid