Provider Demographics
NPI:1811939457
Name:LEBANON FIRE DEPARTMENT FIRST AID AND SAFETY PATROL
Entity type:Organization
Organization Name:LEBANON FIRE DEPARTMENT FIRST AID AND SAFETY PATROL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-272-1234
Mailing Address - Street 1:254 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5918
Mailing Address - Country:US
Mailing Address - Phone:717-272-1234
Mailing Address - Fax:717-270-2875
Practice Address - Street 1:254 S 11TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5918
Practice Address - Country:US
Practice Address - Phone:717-272-1234
Practice Address - Fax:717-270-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA03205341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA280777OtherPA BLUE SHIELD HIGHMARK
PA590645676OtherPALMETTO GBA
PA39EA12OtherCAPITAL BLUE CROSS
PA1511536OtherGATEWAY HEALTH PLAN
PA0007774990010Medicaid
PA265839100OtherUS DEPT OF LABOR
PA0007774990010Medicaid