Healthcare Provider Details

I. General information

NPI: 1447239322
Provider Name (Legal Business Name): LISBON - MT VERNON AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 1ST ST E
MOUNT VERNON IA
52314-1573
US

IV. Provider business mailing address

213 1ST ST W
MOUNT VERNON IA
52314-1604
US

V. Phone/Fax

Practice location:
  • Phone: 319-895-8531
  • Fax: 319-895-8531
Mailing address:
  • Phone: 319-895-6633
  • Fax: 319-895-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2570700
License Number StateIA

VIII. Authorized Official

Name: DR. CRAIG W ALLIN
Title or Position: BOARD PRESIDENT
Credential: PHD
Phone: 319-895-8103