1003979675 NPI number — ACTION AMBULANCE

Table of content: (NPI 1003979675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003979675 NPI number — ACTION AMBULANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTION AMBULANCE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTEGRATED TRANSPORTATION SOLUTIONS, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003979675
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 HWY 44 EAST
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
SHEPHERDSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-619-8839
Provider Business Mailing Address Fax Number:
502-531-0103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4038 PARK 65 DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46254-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-481-9000
Provider Business Practice Location Address Fax Number:
317-481-9002
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'DANIEL
Authorized Official First Name:
STUART
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
502-619-8839

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  0481 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200047550A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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