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Organization

CARLISLE LIONS COMMUNITY AMBULANCE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. MARY ANN DUDLEY 7731397 INTERMEDIATE (CHIEF EXECUTIVE OFFICER)
(812) 398-4693
Entity
Organization

Contact information

Practice address
2549 E COUNTY ROAD 700 S, CARLISLE, IN 47838-8245
(812) 398-4046
(812) 398-9094
Mailing address
3134 MALLARD COVE LN, FORT WAYNE, IN 46804-2882
(260) 436-9495
(260) 436-7235

Taxonomy

Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
0024
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000202117
ANTHEM
IN
05
100281640A
IN
Enumeration date
08/04/2006
Last updated
07/24/2013
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