Provider Demographics
NPI:1992835557
Name:LORDS AMBULANCE SERVICE INC
Entity Type:Organization
Organization Name:LORDS AMBULANCE SERVICE INC
Other - Org Name:LAKESIDE AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-539-7585
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:CENTER OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03814-0490
Mailing Address - Country:US
Mailing Address - Phone:603-539-7585
Mailing Address - Fax:603-569-6214
Practice Address - Street 1:44 CENTER STREET
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894
Practice Address - Country:US
Practice Address - Phone:603-569-2081
Practice Address - Fax:603-569-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
813433OtherBAY STATE HEALTH
H002158OtherCHAMPUS
4620OtherHEALTHSOURCE
A2377OtherEMPIRE BCBS
MA1714767OtherMEDICAID MASS HEALTH UNYS
CT3083574OtherCT MEDICAID
801736OtherTUFTS HEALTH
P00016493OtherRR MEDICARE
MA22F4096OtherMA BCBS MEDEX
NH40006268Medicaid
813433OtherBAY STATE HEALTH
NH40006268Medicaid
P00016493OtherRR MEDICARE