Provider Demographics
NPI:1487868063
Name:LINCOLN VOLUNTEER AMBULANCE SERVICE CORPORATION
Entity Type:Organization
Organization Name:LINCOLN VOLUNTEER AMBULANCE SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NICOLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-362-4313
Mailing Address - Street 1:STEMPLE PASS ROAD
Mailing Address - Street 2:PO BOX 455
Mailing Address - City:LINCOLN
Mailing Address - State:MT
Mailing Address - Zip Code:59639-0455
Mailing Address - Country:US
Mailing Address - Phone:406-362-4313
Mailing Address - Fax:
Practice Address - Street 1:114 STEMPLE PASS ROAD
Practice Address - Street 2:#455
Practice Address - City:LINCOLN
Practice Address - State:MT
Practice Address - Zip Code:59639-0455
Practice Address - Country:US
Practice Address - Phone:406-362-4313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT75341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT44-1220Medicaid