1033393285 NPI number — AMERICARE AMBULANCE SERVICE OF BRADLEY A OTT MBR

Table of content: (NPI 1033393285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033393285 NPI number — AMERICARE AMBULANCE SERVICE OF BRADLEY A OTT MBR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICARE AMBULANCE SERVICE OF BRADLEY A OTT MBR
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:
Provider Other Organization Name Type Code:
6
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:
1033393285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8001 EAST 196TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOBLESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46062-9091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-770-1100
Provider Business Mailing Address Fax Number:
317-770-7002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4651 W WOODS EDGE LN
Provider Second Line Business Practice Location Address:
SUITE # 4
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47304-6088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-863-9115
Provider Business Practice Location Address Fax Number:
765-282-8677
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OTT
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-770-1100

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1111 , 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: 200888630A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000598025 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00706044 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com