Provider Demographics
NPI:1356359145
Name:CARLISLE LIONS COMMUNITY AMBULANCE INC
Entity type:Organization
Organization Name:CARLISLE LIONS COMMUNITY AMBULANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:7731397 INTERMEDIATE
Authorized Official - Phone:812-398-4693
Mailing Address - Street 1:3134 MALLARD COVE LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2882
Mailing Address - Country:US
Mailing Address - Phone:260-436-9495
Mailing Address - Fax:260-436-7235
Practice Address - Street 1:2549 E COUNTY ROAD 700 S
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:47838-8245
Practice Address - Country:US
Practice Address - Phone:812-398-4046
Practice Address - Fax:812-398-9094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00243416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100281640AMedicaid
IN000000202117OtherANTHEM
IN000000202117OtherANTHEM
=========Medicare UPIN