1245214378 NPI number — PERSONAL CARE AMBULANCE TRANSPORT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245214378 NPI number — PERSONAL CARE AMBULANCE TRANSPORT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL CARE AMBULANCE TRANSPORT, 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:
PCAT
Provider Other Organization Name Type Code:
5
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:
1245214378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 CORWIN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KOKOMO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46902-6612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-453-6307
Provider Business Mailing Address Fax Number:
765-453-6382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 CORWIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOKOMO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46902-6612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-453-6307
Provider Business Practice Location Address Fax Number:
765-453-6382
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BEVINGTON
Authorized Official First Name:
COLEY
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
765-453-6307

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0849 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X , with the licence number: 0849 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200491400A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000340627 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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