Organization
PINE GROVE COMMUNITY AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID T. LUKASEWICZ (PRESIDENT)
(570) 617-4002
Entity
Organization
Contact information
Practice address
46 SPRUCE STREET, PINE GROVE, PA 17963-1715
(570) 345-3004
(570) 345-6621
Mailing address
PO BOX 539, MECHANICSBURG, PA 17055-0539
(717) 728-1690
(717) 728-1690
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007646410002
—
PA
Enumeration date
03/05/2007
Last updated
07/02/2010
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