Provider Demographics
NPI:1417968843
Name:LAWTON AMBULANCE
Entity Type:Organization
Organization Name:LAWTON AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-882-9911
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:IA
Mailing Address - Zip Code:51030-0045
Mailing Address - Country:US
Mailing Address - Phone:877-882-9911
Mailing Address - Fax:877-882-9922
Practice Address - Street 1:104 W MAPLE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:IA
Practice Address - Zip Code:51030
Practice Address - Country:US
Practice Address - Phone:877-882-9911
Practice Address - Fax:877-882-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2972400341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0078196Medicaid
IA05631OtherBLUE CROSS
IA05631Medicare PIN
IA0078196Medicaid