Provider Demographics
NPI:1164459053
Name:MFL AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:MFL AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-539-2963
Mailing Address - Street 1:108 NORTH PAGE STREET
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:IA
Mailing Address - Zip Code:52159-0065
Mailing Address - Country:US
Mailing Address - Phone:563-539-2963
Mailing Address - Fax:
Practice Address - Street 1:108 S PAGE ST
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:IA
Practice Address - Zip Code:52159-0065
Practice Address - Country:US
Practice Address - Phone:563-539-2963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22210003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0145763Medicaid
IA14576OtherWELLMARK-BCBS OF IOWA
IA14576Medicare ID - Type Unspecified