Provider Demographics
NPI:1205816360
Name:BUCKS COUNTY RESCUE SQUAD
Entity type:Organization
Organization Name:BUCKS COUNTY RESCUE SQUAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICZBINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-788-0444
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-0535
Mailing Address - Country:US
Mailing Address - Phone:800-927-5845
Mailing Address - Fax:315-635-3289
Practice Address - Street 1:143 KING STREET
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007
Practice Address - Country:US
Practice Address - Phone:215-788-0446
Practice Address - Fax:215-788-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007127430001Medicaid
PA282120Medicare ID - Type Unspecified