Healthcare Provider Details

I. General information

NPI: 1164583365
Provider Name (Legal Business Name): LANSING EMERGENCY MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SOUTH FRONT STREET
LANSING IA
52151-0102
US

IV. Provider business mailing address

40 FIRST STREET SE
WAUKON IA
52172-2022
US

V. Phone/Fax

Practice location:
  • Phone: 563-538-4111
  • Fax:
Mailing address:
  • Phone: 563-568-3411
  • Fax: 563-568-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2030500
License Number StateIA

VIII. Authorized Official

Name: MATT WAGNER
Title or Position: SERVICE DIRECTOR
Credential: EMT-B, R.N.
Phone: 563-538-4111