Provider Demographics
NPI:1265613657
Name:LOVINGTON COMMUNITY AMBULANCE SERVICE INC
Entity type:Organization
Organization Name:LOVINGTON COMMUNITY AMBULANCE SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-691-4400
Mailing Address - Street 1:2938 W PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2476
Mailing Address - Country:US
Mailing Address - Phone:309-691-4400
Mailing Address - Fax:
Practice Address - Street 1:127 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:IL
Practice Address - Zip Code:61937
Practice Address - Country:US
Practice Address - Phone:309-687-5600
Practice Address - Fax:309-687-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL226190Medicare PIN