Provider Demographics
NPI:1447239322
Name:LISBON - MT VERNON AMBULANCE SERVICE
Entity Type:Organization
Organization Name:LISBON - MT VERNON AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-895-8103
Mailing Address - Street 1:213 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IA
Mailing Address - Zip Code:52314-1604
Mailing Address - Country:US
Mailing Address - Phone:319-895-6633
Mailing Address - Fax:319-895-6108
Practice Address - Street 1:730 1ST ST E
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IA
Practice Address - Zip Code:52314-1573
Practice Address - Country:US
Practice Address - Phone:319-895-8531
Practice Address - Fax:319-895-8531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2570700341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0013672Medicaid
01367Medicare ID - Type Unspecified