Carlisle Lions Community Ambulance Inc

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

License

0024 Issued in IN

Legal business name

CARLISLE LIONS COMMUNITY AMBULANCE INC

Practice address

2549 E County Road 700 S
Carlisle, IN 47838-8245

Phone

(812) 398-4046

Fax

(812) 398-9094

NPI assigned

Aug 4, 2006

Last updated

Jul 24, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Ann Dudley, 7731397 INTERMEDIATE

Title

Chief Executive Officer

Phone

(812) 398-4693

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374624000000",
    "number": "1356359145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3134 MALLARD COVE LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468042882",
            "telephone_number": "260-436-9495",
            "fax_number": "260-436-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2549 E COUNTY ROAD 700 S",
            "city": "CARLISLE",
            "state": "IN",
            "postal_code": "478388245",
            "telephone_number": "812-398-4046",
            "fax_number": "812-398-9094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLISLE LIONS COMMUNITY AMBULANCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2013-07-24",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "812-398-4693",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "7731397 INTERMEDIATE"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "IN",
            "license": "0024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100281640A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000202117",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Bedwell, APN
• Christina N Cox
• Cassandra Jennings, PSYD, HSPP
• Latasha Nichole Jones, FNP-C
• Kayla Marie Kellams, MSN,FNP-C
• Mso Clinics, Inc. (Carlisle Medical Clinic)

• Land Ambulance in Carlisle, IN
• Providers in Carlisle, IN by specialty
• Land Ambulance in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.