Provider Demographics
NPI:1285784710
Name:NORTHEAST LINN AMBULANCE SERVICE INC.
Entity type:Organization
Organization Name:NORTHEAST LINN AMBULANCE SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SERVICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:319-438-1772
Mailing Address - Street 1:332 COMMERCIAL ST.
Mailing Address - Street 2:PO BOX 369
Mailing Address - City:CENTRAL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52214-0369
Mailing Address - Country:US
Mailing Address - Phone:319-438-1772
Mailing Address - Fax:
Practice Address - Street 1:332 COMMERCIAL ST.
Practice Address - Street 2:332 COMMERCIAL ST.
Practice Address - City:CENTRAL CITY
Practice Address - State:IA
Practice Address - Zip Code:52214-0369
Practice Address - Country:US
Practice Address - Phone:319-438-1772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0030783Medicaid
IA0030783Medicaid