1770859175 NPI number — PROMPT AMBULANCE CENTRAL, INC.

Table of content: (NPI 1770859175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770859175 NPI number — PROMPT AMBULANCE CENTRAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROMPT AMBULANCE CENTRAL, INC.
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:
1770859175
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 KEPNER DRIVE
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-448-4327
Provider Business Mailing Address Fax Number:
765-448-4694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 KEPNER DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-7427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-448-4327
Provider Business Practice Location Address Fax Number:
765-448-4694
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-838-4444

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0150 , 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: 201062000A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01089849 . 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