Provider Demographics
NPI:1245298751
Name:LAFAYETTE AMBULANCE AND RESCUE SQUAD, INC.
Entity type:Organization
Organization Name:LAFAYETTE AMBULANCE AND RESCUE SQUAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-992-0399
Mailing Address - Street 1:180 N HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2123
Mailing Address - Country:US
Mailing Address - Phone:610-992-0399
Mailing Address - Fax:610-992-0162
Practice Address - Street 1:180 N HENDERSON RD
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2123
Practice Address - Country:US
Practice Address - Phone:610-992-0399
Practice Address - Fax:610-992-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03158341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012648720004Medicaid
PA000281328OtherHIGHMARK BLUECROSS BLUESH
PA20036290OtherAMERIHEALTH MERCY HEALTH
PA0049083000OtherKEYSTONE HEALTH PLAN EAST
PAX000238501OtherAMERICHOICE OF PA
PA281328OtherHIGHMARK BLUESHIELD
PA0049083000OtherIBC PERSONAL CHOICE
PA07949OtherHEALTHPARTNERS
PA281328OtherINDEPENDENCE BLUE CROSS
PA281328OtherCAPITAL BLUE CROSS
PA281328OtherSTATE WORKERS INSURANCE F
PA000281328OtherUNITED HEALTHCARE INSURAN
PAX000238501OtherAMERICHOICE OF PA