Provider Demographics
NPI:1205995263
Name:LACKAWAXEN TOWNSHIP VOLUNTEER AMBULANCE SERVICE
Entity type:Organization
Organization Name:LACKAWAXEN TOWNSHIP VOLUNTEER AMBULANCE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-685-4022
Mailing Address - Street 1:109 ROUTE 590
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18425-9743
Mailing Address - Country:US
Mailing Address - Phone:570-685-4022
Mailing Address - Fax:
Practice Address - Street 1:1611 ROUTE 590
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7794
Practice Address - Country:US
Practice Address - Phone:570-685-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013026140006Medicaid
PA081118OtherFIRST PRIORITY HEALTH
PA612359700OtherUS DEPARTMENT OF LABOR
PA200955Medicare PIN
PA612359700OtherUS DEPARTMENT OF LABOR