1356359145 NPI number — CARLISLE LIONS COMMUNITY AMBULANCE INC

Table of content: (NPI 1356359145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356359145 NPI number — CARLISLE LIONS COMMUNITY AMBULANCE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLISLE LIONS COMMUNITY AMBULANCE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356359145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3134 MALLARD COVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46804-2882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-436-9495
Provider Business Mailing Address Fax Number:
260-436-7235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2549 E COUNTY ROAD 700 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47838-8245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-398-4046
Provider Business Practice Location Address Fax Number:
812-398-9094
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUDLEY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
812-398-4693

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0024 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100281640A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000202117 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".