Provider Demographics
NPI:1164583365
Name:LANSING EMERGENCY MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:LANSING EMERGENCY MEDICAL SERVICES, INC.
Other - Org Name:LANSING EMS
Other - Org Type:Other Name
Authorized Official - Title/Position:SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B, RN
Authorized Official - Phone:563-538-4111
Mailing Address - Street 1:40 FIRST STREET SE
Mailing Address - Street 2:
Mailing Address - City:WAUKON
Mailing Address - State:IA
Mailing Address - Zip Code:52172-2022
Mailing Address - Country:US
Mailing Address - Phone:563-568-3411
Mailing Address - Fax:563-568-6139
Practice Address - Street 1:51 SOUTH FRONT STREET
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IA
Practice Address - Zip Code:52151-0102
Practice Address - Country:US
Practice Address - Phone:563-538-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20305003416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA99971OtherWELLMARK BCBS OF IA
IA33887OtherBLUE CROSS & BLUE SHIELD
IAIB1357Medicare PIN