1346419496 NPI number — HEARTSAVERS EMS LLC

Table of content: ELIZABETH JOAN ISENSEE CPO, LPO, MPO (NPI 1235643933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346419496 NPI number — HEARTSAVERS EMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEARTSAVERS EMS 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:
Provider Other Organization Name Type Code:
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:
1346419496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3645 E MAIN ST # 168
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47374-5934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-827-4010
Provider Business Mailing Address Fax Number:
765-827-4013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 CENTRAL 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:
47331-0445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-827-4010
Provider Business Practice Location Address Fax Number:
765-827-4013
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MUNS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
765-827-4010

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1104 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 1104 , 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: 200875720A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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