Organization
LACEYVILLE AMBULANCE ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC RYAN SHAFER (CAPTAIN)
(570) 869-2778
Entity
Organization
Contact information
Practice address
12 EAST MAIN STREET, LACEYVILLE, PA 18623
(570) 282-5652
(570) 282-5653
Mailing address
PO BOX 274, LACEYVILLE, PA 18623-0274
(570) 282-5652
(570) 282-5653
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
05178
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012067070001
—
PA
Enumeration date
08/24/2007
Last updated
10/14/2009
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