1649691494 NPI number — PRECISION AMBULANCE LLC

Table of content: (NPI 1649691494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649691494 NPI number — PRECISION AMBULANCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION AMBULANCE LLC
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:
ST CLAIR EMS
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:
1649691494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 424
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONNERSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47331-0424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-222-1062
Provider Business Mailing Address Fax Number:
765-222-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
722 N EASTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNERSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47331-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-222-1062
Provider Business Practice Location Address Fax Number:
765-222-1190
Provider Enumeration Date:
12/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ST CLAIR
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
765-222-1062

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  2371 , 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: 201217210A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000855060 . This is a "ANTHEM BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P10297344 . This is a "PALMETTO RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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