Healthcare Provider Details

I. General information

NPI: 1417968843
Provider Name (Legal Business Name): LAWTON AMBULANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W MAPLE
LAWTON IA
51030
US

IV. Provider business mailing address

PO BOX 45
LAWTON IA
51030-0045
US

V. Phone/Fax

Practice location:
  • Phone: 877-882-9911
  • Fax: 877-882-9922
Mailing address:
  • Phone: 877-882-9911
  • Fax: 877-882-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2972400
License Number StateIA

VIII. Authorized Official

Name: MRS. MICHELE SMITH
Title or Position: ACCOUNT REPRESENTATIVE
Credential:
Phone: 605-882-9911